Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, A. S. G.; Bardhan, Pradip Kumar; Hossain, Iqbal; Shahid, Abu S. M. S. B.; Shahunja, K. M.; Das, Sumon Kumar; Imran, Gazi; Ahmed, Tahmeed

doi:10.1371/journal.pone.0073728

Cited by 42 publications

(51 citation statements)

References 30 publications

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“…The risk of death among under‐five children with severe wasting is approximately 10 times higher as compared with those with weight‐for‐height z ‐score (WHZ) > −1 SD (Black et al, ). Severe wasting increases the incidence and severity of common childhood illnesses like diarrhoea and pneumonia (Chisti et al, ; Jones & Berkley, ; Talbert et al, ). Severe wasting in children aged less than 6 months of postnatal life may also affect long‐term developmental outcomes (Lelijveld et al, ).…”

Section: Introductionmentioning

confidence: 99%

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Choudhary

Srivastava

Chowdhury

et al. 2019

Maternal & Child Nutrition

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Burden and risk factors for wasting in the first 6 months of life among Indian children are not well documented. We used data from India's National Family Health Survey 4 to estimate the prevalence of severe wasting (weight for length < ‐3 SD) among 18,898 infants under 6 months of age. We also examined the association of severe wasting with household, maternal, and child‐related factors using multivariable logistic regression analysis. Prevalence of severe wasting among infants less than 6 months of age was 14.8%, ranging from 3.5 to 21% across states. Low birth weight (<2,500 g; adjusted odds ratio [AOR] 1.40, 95% CI [1.19, 1.65]), nonutilization of supplementary nutrition by mother during lactation (AOR 1.23, 95% CI [1.05, 1.43]), and anthropometric assessment during summer (AOR 1.37, 95% CI [1.13, 1.65]) and monsoon months (AOR 1.53, 95% CI [1.20, 1.95]) were associated with higher odds of severe wasting. Infants aged 2 to 3 months (AOR 0.78, 95% CI [0.66, 0.93]) and 4 to 5 months (AOR 0.65, 95% CI [0.55, 0.73]) had lower odds of severe wasting as compared with the 0‐ to 1‐month category. This analysis reveals a high burden of severe wasting in infants less than 6 months in India. Preventive interventions must be targeted at reducing low birth weight due to fatal growth restriction and prematurity. Appropriate care practices at facilities and postdischarge with extra attention to those born small and sick can prevent further deterioration in nutritional status.

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Section: Introductionmentioning

confidence: 99%

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Choudhary

Srivastava

Chowdhury

et al. 2019

Maternal & Child Nutrition

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“…[6][7][8] Most studies of hypoxemia in children with pneumonia were performed in one country and rarely investigated the relationship between hypoxemia and microbiological results, so it would be useful to reassess them in a more recent multicontinental investigation. 2 The risk factors of death among children with pneumonia in developing countries have already been identified, 9,10 but rarely regarding the relationship between microbiological findings and mortality. Assessment of clinical, para-clinical, and microbiological predictors of death would be useful to prioritize public health campaigns.…”

Section: Introductionmentioning

confidence: 99%

Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study

Bénet

Picot

Awasthi

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Abstract.Pneumonia is the leading cause of death in children. The objectives were to evaluate the microbiological agents linked with hypoxemia in hospitalized children with pneumonia from developing countries, to identify predictors of hypoxemia, and to characterize factors associated with in-hospital mortality. A multicenter, observational study was conducted in five hospitals, from India (Lucknow, Vadu), Madagascar (Antananarivo), Mali (Bamako), and Paraguay (San Lorenzo). Children aged 2–60 months with radiologically confirmed pneumonia were enrolled prospectively. Respiratory and whole blood specimens were collected, identifying viruses and bacteria by real-time multiplex polymerase chain reaction (PCR). Microbiological agents linked with hypoxemia at admission (oxygen saturation < 90%) were analyzed by multivariate logistic regression, and factors associated with 14-day in-hospital mortality were assessed by bivariate Cox regression. Overall, 405 pneumonia cases (3,338 hospitalization days) were analyzed; 13 patients died within 14 days of hospitalization. Hypoxemia prevalence was 17.3%. Detection of human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) in respiratory samples was independently associated with increased risk of hypoxemia (adjusted odds ratio [aOR] = 2.4, 95% confidence interval [95% CI] = 1.0–5.8 and aOR = 2.5, 95% CI = 1.1–5.3, respectively). Lower chest indrawing and cyanosis were predictive of hypoxemia (positive likelihood ratios = 2.3 and 2.4, respectively). Predictors of death were Streptococcus pneumoniae detection by blood PCR (crude hazard ratio [cHR] = 4.6, 95% CI = 1.5–14.0), procalcitonin ≥ 50 ng/mL (cHR = 22.4, 95% CI = 7.3–68.5) and hypoxemia (cHR = 4.8, 95% CI = 1.6–14.4). These findings were consistent on bivariate analysis. hMPV and RSV in respiratory samples were linked with hypoxemia, and S. pneumoniae in blood was associated with increased risk of death among hospitalized children with pneumonia in developing countries.

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“…Pneumonia is the most common complication in the non-responder group. (8) In our study of 19 cases, the underlying causes were as follows:…”

Section: Indicatormentioning

confidence: 87%

Outcome Study of NRC in Andhra Pradesh

Manjula¹,

Nirmala²,

Nethagani³

et al. 2016

jemds

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BACKGROUNDThis is an outcome study done in an NRC unit attached to teaching hospital, the results of which are not up to the mark; 30 NRCs were established all across Andhra Pradesh and all staff trained regarding protocol based on management of severe acute malnutrition; protocol based management is specially set for them taking into account their altered physiology. In the wake of high prevalence of SAM (Severe Acute Malnutrition) and the high mortality associated with it, facility based management to reduce mortality has been started with good results. This is an outcome study on NRC (Nutritional Rehabilitation Centre) in South India.

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Clinical Risk Factors of Death From Pneumonia in Children with Severe Acute Malnutrition in an Urban Critical Care Ward of Bangladesh

Cited by 42 publications

References 30 publications

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Severe wasting among Indian infants <6 months: Findings from the National Family Health Survey 4

Severity of Pneumonia in Under 5-Year-Old Children from Developing Countries: A Multicenter, Prospective, Observational Study

Outcome Study of NRC in Andhra Pradesh

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