A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China

Zhang, Qingli; Guo, Zhiru; Bai, Zhidong; MacDonald, Noni E.

doi:10.1002/ppul.22608

Cited by 55 publications

(71 citation statements)

References 28 publications

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“…They found that young age (≤12 months old) and congenital heart diseases were significantly associated with the need for intensive care admission. They also found that children with Down syndrome and immunodeficiency had higher mortality [18]. Unlike Zhang et al’s study, in our cohort, a diagnosis of chronic lung disease not congenital heart disease was associated with life- threatening LRTIs.…”

Section: Discussioncontrasting

confidence: 67%

Clinical Risk Factors for Life-Threatening Lower Respiratory Tract Infections in Children: A Retrospective Study in an Urban City in Malaysia

et al. 2014

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AimLower respiratory tract infections (LRTIs) are an important cause of morbidity and mortality, especially in low income countries. The aim of this study was to determine risk factors of life-threatening LRTIs in hospitalised children in Malaysia.MethodsThis retrospective study included children aged less than 18 years admitted for LRTIs over 13 months in a tertiary referral centre in Kuala Lumpur, Malaysia. Neonates, children with asthma and those with either no or a normal chest radiograph were excluded. Life-threatening infection was defined as that needing non-invasive ventilation or admission to the paediatric intensive care unit. Routine blood investigations and nasopharyngeal secretion results (bacterial and viral) were obtained. Chest radiographs were reviewed by a designated radiologist. Environmental data (rainfall, particulate matter ≤10 µm [PM10] and air pollution index [API]) was obtained from the respective government departments.ResultsThree hundred and ninety-one episodes of LRTIs were included. Viruses were implicated in 48.5% of LRTIs, with respiratory syncytial virus (RSV) being detected in 44% of viral LRTIs. Forty-six (11.8%) children had life-threatening disease and the overall mortality rate was 1.3% (5 children). RSV was detected in 26% of children with life-threatening LRTIs. In multivariate logistic regression, chronic lung disease, presenting history of apnoea and signs of hypoxia, was associated with life threatening LRTIs. Increased LRTI admissions were associated with low rainfall but not PM10 nor API. Of those on follow-up, 39% had persistent respiratory symptoms.ConclusionOne in nine children admitted with LRTI had a life-threatening LRTI. The aetiology was viral in almost half of admitted children. RSV was detected in a quarter of children with life-threatening LRTIs. Children who present with LRTIs and either have chronic lung disease, presenting history of apnoea or signs of hypoxia, should be observed carefully as the risk of deterioration to life-threatening illness is high.

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Section: Discussioncontrasting

confidence: 67%

Clinical Risk Factors for Life-Threatening Lower Respiratory Tract Infections in Children: A Retrospective Study in an Urban City in Malaysia

et al. 2014

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“…Association of underlying congenital heart disease with pneumonia mortality reported between 7-12% within the groups [5] is comparable to other studies from India though much higher figures have been reported from China [2]. Presence of co-morbidities, in this study particularly diarrhea and HIV, has been reported as an important risk factor for severe pneumonia in areas with high prevalence of HIV [4].…”

supporting

confidence: 83%

“…A study from Delhi [1] has demonstrated this important association of severity of illness with CFR ranging from 0-47% in children with pneumonia, severe pneumonia, and very severe pneumonia as per WHO classification. In the study by Ramachandran, et al [5] 47-68% of the children who died required assisted ventilation which is much higher than reported by others [2]. It is difficult to understand the VOLUME 49 __ NOVEMBER 16, 2012 EDITORIALS practical importance of this association because the clinical course and pathway to death can not be visualized if the cases are not categorized based on severity of illness at the time of admission.…”

mentioning

confidence: 92%

“…Significant independent predictors of mortality in children with pneumonia reported earlier by several prospective studies relate to host characteristics (age less than 1 year, lack of exclusive breastfeeding), severity of infection (severe roentgenogram changes, leukocytosis, bandemia), worsening of clinical condition, and hypoxemia (inability to feed, grunting, head nodding, respiratory rate >70/minute, severe chest indrawing, cyanosis), severe malnutrition (weight for age Z score <-3) and associated co-morbidities like diarrhea and HIV [1][2][3][4].…”

mentioning

confidence: 99%

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Risk factors for mortality in children hospitalized with pneumonia

Patwari

2012

Indian Pediatr

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“…In previous literature, iron deficiency has been reported as a comorbidity associated with influenza A . In addition, anaemia has been identified as a risk factor for respiratory failure in children admitted to hospital for community‐acquired pneumonia . Iron has many important functions in the body including regulation of the immune system, and therefore, deficiency could compromise immune function and impact on acquisition and severity of infections including influenza.…”

Section: Discussionmentioning

confidence: 99%

Retrospective review of factors associated with severe hospitalised community‐acquired influenza in a tertiary paediatric hospital in South Australia

Lakhan

Clarke

Mathew

et al. 2016

Influenza Resp Viruses

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BackgroundInfluenza infection can result in severe disease with debilitating complications. Young children have the highest rate of influenza hospitalisations with various factors influencing influenza susceptibility and severity.ObjectivesThis study aimed to determine the disease burden and assess risk factors for severe hospitalised influenza in South Australian children under 5 years of age.MethodsInfluenza admissions to the tertiary paediatric hospital in South Australia from 2008 to 2012 were identified. Data from laboratory‐confirmed influenza cases were collected, including infecting influenza strain, co‐infections, prematurity, pre‐existing medical comorbidities and other potential risk factors. Predictors of high‐level care were assessed using logistic regression.ResultsA total of 267 children with laboratory‐confirmed influenza were hospitalised. Of these, 147 admissions (53%) occurred in children without underlying medical risk factors. Eighteen children (7%) required high‐level care, of which 11 (61%) had no underlying medical risk factors. No deaths were reported. The majority of children were unimmunised against influenza. Co‐infections were identified in 40% of children (n = 107). Influenza B was associated with a requirement for higher care (OR 3.7, CI 1.3–10.9, P = .02) as was a history of food allergies (OR 9.7, CI 1.5–61.4, P = .02) and iron deficiency anaemia (OR 4.8, CI 1.4–16.1, P = .01).ConclusionsInfluenza can be a severe illness, even in children without underlying medical conditions. The identification of Influenza B strain, history of food allergies and iron deficiency anaemia as predictors of severity in hospitalised cases warrants further investigation and may have important implications for preventative strategies to reduce the burden of childhood influenza.

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A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China

Abstract: Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality.

Cited by 55 publications

References 28 publications

Clinical Risk Factors for Life-Threatening Lower Respiratory Tract Infections in Children: A Retrospective Study in an Urban City in Malaysia

Clinical Risk Factors for Life-Threatening Lower Respiratory Tract Infections in Children: A Retrospective Study in an Urban City in Malaysia

Risk factors for mortality in children hospitalized with pneumonia

Retrospective review of factors associated with severe hospitalised community‐acquired influenza in a tertiary paediatric hospital in South Australia

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