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2013 ; 48
(4
): 390-7
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A 4 year prospective study to determine risk factors for severe community
acquired pneumonia in children in southern China
#MMPMID22778084
Zhang Q
; Guo Z
; Bai Z
; MacDonald NE
Pediatr Pulmonol
2013[Apr]; 48
(4
): 390-7
PMID22778084
show ga
BACKGROUND: Pneumonia is the major cause of death under 5 years. With high CAP
numbers in China and growing access to PICUs, factors associated with severe CAP
need to be determined to optimize care. OBJECTIVE: To prospectively determine
PICU CAP admission features and outcomes. METHODS: A 4 year prospective study of
CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to
Soochow University, China. All were managed in a standard manner. Clinical,
laboratory, and imaging findings were collected systematically. All received
antibiotics. RESULTS: Eight hundred ten (7%) of 10,836 CAP hospital admissions
needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were
young (76%???12 months) and 33% had co-morbid conditions; 21% congenital heart
disease.21% required mechanical ventilation. The average length of PICU stay was
5 days (range, 3-27). The case fatality rate was 5.8%. Viruses were detected in
38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza
b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate
>70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated
with respiratory failure and with fatality. On multivariate analysis only
presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated
with fatality; not microbe nor PICU findings. CONCLUSIONS: 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.
|*Critical Care/methods/statistics & numerical data
[MESH]