Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit

Koh, Jia Wen Janine Cynthia; Wong, Judith Ju‐Ming; Sultana, Rehena; Wong, Petrina; Mok, Yee Hui; Lee, Jan Hau

doi:10.1002/ppul.23702

Cited by 38 publications

(50 citation statements)

References 35 publications

(46 reference statements)

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“…Bronchopneumonia contributed to one‐fourths of all PICU admissions and almost two‐thirds of respiratory admissions; these values though comparable with few other studies, was much higher than the most . Diagnosis of bronchopneumonia itself has been associated with increased risk of mortality in many studies; the study by Pilar et al on ARI in PICU reported a 7.8 times increased risk of death by bronchopneumonia as compared with other diagnosis in ARI .…”

Section: Discussionsupporting

confidence: 63%

“…6,8,15,17,[19][20][21] Bronchopneumonia contributed to one-fourths of all PICU admissions and almost two-thirds of respiratory admissions; these values though comparable with few other studies, was much higher than the most. 5,6,14,[22][23][24] Diagnosis of bronchopneumonia itself has been associated with increased risk of mortality in many studies; the study by Pilar et al on ARI in PICU reported a 7.8 times increased risk of death by bronchopneumonia as compared with other diagnosis in ARI. 22,25 The significant contribution to admissions by bronchopneumonia and increased risk of mortality warrant an underlying need to focus on these children for better outcome.…”

Section: Discussionmentioning

confidence: 99%

“…32,33 The need for mechanical ventilation (almost two-thirds of study group) in our analyses was comparable with studies in Brazil and Singapore but much higher well as other developed countries. 5,7,22,24,29,[34][35][36][37] This could be due to the fact that our study focused primarily on respiratory admissions (more likely to be ventilated), while most other studies reported ventilation data for entire PICU populations. Mortality in those ventilated by us (46.2%) was comparable with studies from Asia and Turkey, but much higher than overall mortality in those mechanically ventilated in PICUs in developed countries.…”

Section: Discussionmentioning

confidence: 99%

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Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country

Divecha¹,

Tullu²,

Chaudhary³

2019

Pediatric Pulmonology

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Introduction and Objectives Acute respiratory infections (ARI), a major cause of childhood mortality and morbidity, place substantial burden on health services worldwide. Due to scarce data regarding respiratory illnesses requiring Pediatric intensive care unit (PICU) admissions (especially in low income/developing countries), we studied the burden of respiratory illnesses in the PICU and the risk factors contributing to mortality. Methods This prospective observational study was conducted over 18 months. Children (aged 1 month to 12 years) admitted to the PICU for acute respiratory/cardiorespiratory illnesses were enrolled. Demographic and clinical details of the study population were recorded and tabulated. Risk factors contributing to mortality (severity of illness [PRISM III score], diagnosis/etiology, need for mechanical ventilation, immunocompromised status, malnutrition, and length of stay [LOS]) were analyzed (using the χ2 test or Fischer Exact test). Results Two hundred and ninety‐three children were enrolled (median age: 5 months; range, 1‐132 months; male/female: 181/112). Mean LOS in PICU was 5.25 ± 5.48 days and mean length of hospital stay of 14.82 ± 13.35 days. Mechanical ventilation was required in 62.8% cases. Pneumonia contributed to 66.89% of respiratory admissions and 91% of mortality. Ninety patients (30.7%) died; mortality being higher in cardiorespiratory cases (52.7%). PRISM III score and shock (respiratory cases) and age below 1 year (cardiorespiratory group) were significantly associated with higher mortality ( P < 0.05). Conclusions Respiratory illnesses are a significant contributor to PICU admissions and are associated with significant mortality risk in presence of high PRISM III score and shock (respiratory group); and age below 1 year (cardiorespiratory group).

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country

Divecha¹,

Tullu²,

Chaudhary³

2019

Pediatric Pulmonology

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“… 17 There are continuing concerns of clinically important mortality in children with indrawing pneumonia in Africa. 21 This has led to hesitation to adopt new WHO and Kenyan guidelines that now recommend the treatment of indrawing pneumonia as an outpatient using amoxicillin. 11 19 Our results suggest that there are likely to be two distinct issues.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: a retrospective observational study

et al. 2017

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ObjectivesKenyan guidelines for antibiotic treatment of pneumonia recommended treatment of pneumonia characterised by indrawing with injectable penicillin alone in inpatient settings until early 2016. At this point, they were revised becoming consistent with WHO guidance after results of a Kenyan trial provided further evidence of equivalence of oral amoxicillin and injectable penicillin. This change also made possible use of oral amoxicillin for outpatient treatment in this patient group. However, given non-trivial mortality in Kenyan children with indrawing pneumonia, it remained possible they would benefit from a broader spectrum antibiotic regimen. Therefore, we compared the effectiveness of injectable penicillin monotherapy with a regimen combining penicillin with gentamicin.SettingWe used a large routine observational dataset that captures data on all admissions to 13 Kenyan county hospitals.Participants and measuresThe analyses included children aged 2–59 months. Selection of study population was based on inclusion criteria typical of a prospective trial, primary analysis (experiment 1, n=4002), but we also explored more pragmatic inclusion criteria (experiment 2, n=6420) as part of a secondary analysis. To overcome the challenges associated with the non-random allocation of treatments and missing data, we used propensity score (PS) methods and multiple imputation to minimise bias. Further, we estimated mortality risk ratios using log binomial regression and conducted sensitivity analyses using an instrumental variable and PS trimming.ResultsThe estimated risk of dying, in experiment 1, in those receiving penicillin plus gentamicin was 1.46 (0.85 to 2.43) compared with the penicillin monotherapy group. In experiment 2, the estimated risk was 1.04(0.76 to 1.40).ConclusionThere is no statistical difference in the treatment of indrawing pneumonia with either penicillin or penicillin plus gentamicin. By extension, it is unlikely that treatment with penicillin plus gentamicin would offer an advantage to treatment with oral amoxicillin.

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“…Bacterial pneumonia in the ICU setting is associated with significant morbidity and mortality. Koh et al retrospectively reviewed a 4‐year series of 237 children with severe pneumonia admitted to a pediatric ICU in Singapore, to identify risk factors for mortality, which occurred in 13.5% of this series. A sole bacterial or viral infection was identified in 20% and 18% of patients respectively, while multiple pathogens were detected in 26%.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Pulmonology year in review 2017: Part 3

Ren

Muston

Yılmaz

et al. 2018

Pediatric Pulmonology

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Our journal covers a broad range of research and scholarly topics related to children's respiratory disorders. For updated perspectives on the rapidly expanding knowledge in our field, we will summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages. The current review covers articles on neonatal lung disease, pulmonary physiology, and respiratory infection.Word count: 71 3

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Risk factors for mortality in children with pneumonia admitted to the pediatric intensive care unit

Abstract: Severe pediatric pneumonia accounts for a significant number of PICU admissions and is associated with significant mortality risk. The presence of co-morbidities, HAP and bacteremia were early prognostic variables independently associated with poor clinical outcomes.

Cited by 38 publications

References 35 publications

Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country

Burden of respiratory illnesses in pediatric intensive care unit and predictors of mortality: Experience from a low resource country

Comparative effectiveness of injectable penicillin versus a combination of penicillin and gentamicin in children with pneumonia characterised by indrawing in Kenya: a retrospective observational study

Pediatric Pulmonology year in review 2017: Part 3

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