Prevalence, Predictive Factors, and Outcomes of Respiratory Failure in Children With Pneumonia Admitted in a Developing Country

Abstract

BackgroundPneumonia has been the leading infectious cause of morbidity and mortality in children under 5 years of age for the last several decades. Although most of these deaths occur due to respiratory failure, published data are limited regarding predicting factors and outcomes of respiratory failure in children hospitalized with pneumonia or severe pneumonia.ObjectiveThis study aimed to explore the prevalence, predicting factors, and outcomes of respiratory failure in children under-five with pneumonia or severe pneumonia.MethodsIn this retrospective chart analysis, we enrolled children under 5 years of age hospitalized with pneumonia or severe pneumonia in the Dhaka Hospital of International Centre for Diarrheal Disease Research, Bangladesh (icddr,b) between August 2013 and December 2017. Comparisons were made between children with respiratory failure (n = 212) and those without respiratory failure (n = 4,412). Respiratory failure was defined when the oxygen saturation/fraction of inspired oxygen (SpO2/FiO2) was <315.ResultsA total of 4,625 children with pneumonia or severe pneumonia were admitted during this study period. Among them, 212 (4.6%) children developed respiratory failure and formed the case group. A total of 4,412 (95.3%) children did not develop respiratory failure and formed the comparison group. In logistic regression analysis, after adjusting with potential confounders, severe sepsis [adjusted odds ratio (aOR): 12.68, 95% CI: 8.74–18.40], convulsion (aOR: 4.52, 95% CI: 3.06–6.68), anemia (aOR: 1.76, 95% CI: 1.20–2.57), and severe underweight (aOR: 1.97, 95% CI: 1.34–2.89) were found to be independently associated with respiratory failure. As expected, children with respiratory failure more often had fatal outcome than without respiratory failure (74, 1%, p < 0.001).ConclusionThe results of our analyses revealed that prevalence of respiratory failure was 4.6% among under-five children hospitalized for pneumonia or severe pneumonia. Severe sepsis, convulsion, anemia, and severe underweight were the independent predictors for respiratory failure in such children and their case-fatality rate was significantly higher than those without respiratory failure. Early recognition of these predicting factors of respiratory failure may help clinicians imitating prompt treatment that may further help to reduce deaths in such children, especially in resource-limited settings.

Implementation of bubble continuous positive airway pressure for children with severe pneumonia and hypoxemia in intensive care unit of Dhaka Hospital, Bangladesh—Effect on pneumonia mortality

“…Respiratory failure was defined if a child had severe labored respiration and hypoxemia having oxygen saturation/fraction of inspired oxygen (SpO 2 /FiO 2 ) less than 315. 9 For calculating FiO 2 in a patient receiving oxygen, we added 4% for each liter of oxygen to the FiO 2 in room air (21%). 10…”

“…The trial exclusion criteria were an indication for mechanical ventilation (such as apnea, respiratory failure with or without requirement of cardiopulmonary resuscitation, coma, or unconsciousness), congenital heart disease, or cleft lip and/or cleft palate. Respiratory failure was defined if a child had severe labored respiration and hypoxemia having oxygen saturation/fraction of inspired oxygen (SpO 2 /FiO 2 ) less than 315 9 . For calculating FiO 2 in a patient receiving oxygen, we added 4% for each liter of oxygen to the FiO 2 in room air (21%) 10…”

Association of anthropometric z score with complications and length of hospital stay in children with severe pneumonia aged 3 months to 5 years

“…Nutrition status is an influential factor in the prognosis of severe pneumonia. 22 The WHO issued growth standards for children under 5 years of age, and anthropometric z scores are used to evaluate the growth level of children. The Society of Pediatrics of the Chinese Medical Association recommends anthropometric z score evaluation of children's growth and development.…”

“…Nutrition status is an influential factor in the prognosis of severe pneumonia 22 . The WHO issued growth standards for children under 5 years of age, and anthropometric z scores are used to evaluate the growth level of children.…”

Prevalence and outcome of anemia among children hospitalized for pneumonia and their risk of mortality in a developing country

“…We have also used evidence-based definition of severe sepsis 14 . Respiratory failure was defined if the proportion of arterial oxygen saturation (measured by using a pulse oximeter) and fraction of inspired oxygen (SpO 2 /FiO 2 ) was < 315 15 . Abnormal mental status was defined if a child had restlessness, or lethargy, or coma, or unconsciousness.…”