Factors determining the outcome of children hospitalized with severe pneumonia.
Factors determining the outcome of children hospitalized with severe pneumonia.
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DOI：
10.1186/1471-2431-9-15
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发表时间：
2009-02-23
期刊：
影响因子：
2.4
通讯作者：
Kabra SK
中科院分区：
文献类型：
--
作者：
Tiewsoh K;Lodha R;Pandey RM;Broor S;Kalaivani M;Kabra SK
肺炎是五岁以下儿童发病和死亡的主要原因之一。我们进行了一项全面的研究，以确定影响5岁以下重症肺炎住院儿童死亡率和发病率的因素。200名年龄2-60个月的世界卫生组织（WHO）定义的重症肺炎住院儿童入组研究。这些孩子是使用标准协议管理的。对他们进行了密切随访，以了解是否需要更换抗生素、延长住院时间、是否需要机械通气和死亡率。收集影响结果的因素的数据。在200名儿童中，113名（56.5%）需要更换抗生素，102名（51%）住院超过5天，41名（20.5%）需要机械通气，21名（10.5%）死亡。多变量分析显示，缺乏纯母乳喂养[RR（95%CI）2.63（2.16-2.86）]、过度拥挤[RR（95%CI）1.94（1.35-2.38）]和胸部X线检查异常[RR（95%CI）2.29（1.22-3.44）]与需要更换抗生素相关。缺乏纯母乳喂养[RR（95%CI）2.56（2.0-2.93）]、过度拥挤[RR（95%CI）2.59（1.78-3.23）]和胸部X线检查异常[RR（95%CI）2.99（1.65-4.38）]被确定为延长住院时间的决定因素。点头[RR（95%CI）8.34（2.71-12.77）]、感觉改变[RR（95%CI）5.44（1.34-17.56）]、白细胞计数异常[RR（95%CI）5.85（1.36-17.14）]和苍白[RR（95%C）10.88（2.95-20.40）]与死亡率相关。点头（RR（95%CI）4.73（1.50-6.36））和发绀（RR（95%CI）5.06（1.80-11.34））是机械通气的决定因素。在影像学证实的肺炎中，抗生素变化的决定因素是：缺乏纯母乳喂养[RR（95% CI）2.05（1.69-2.2）]和低出生体重[RR（95% CI）1.59（1.1-1.89）]。对于延长住院时间，确定的因素是母亲的教育程度低于毕业[RR（95%CI）1.5（1.19-1.7）]，缺乏纯母乳喂养[RR（95%CI）1.77（1.19-2.09）]和就诊时血氧饱和度< 90%[RR（95%CI）2.06（1.42-2.42）]。机械通气的决定因素是母亲教育程度低于毕业[RR（95%CI）3.6（1.15-6.3）]和就诊时发绀[RR（95%CI）10.9（1.56-18.9）]。对于死亡率，唯一的决定因素是苍白[RR（95% CI）10.54（1.8-21.79）]。患有严重社区获得性肺炎[根据世界卫生组织（WHO）的定义]的住院儿童，如果没有接受纯母乳喂养，住在过度拥挤的家中，并且胸部X光片异常，则更有可能对主要抗生素方案无效，需要更换抗生素和延长住院时间。在经放射学证实的肺炎患儿中，缺乏母乳喂养和低出生体重与抗生素的改变有关。
Pneumonia is one of the leading causes of morbidity and mortality in under fives. We carried out a comprehensive study to identify factors influencing both mortality and morbidity for children less than 5 years of age hospitalized with severe pneumonia. 200 hospitalized children aged 2–60 months with World Health Organization (WHO) defined severe pneumonia were enrolled in the study. The children were managed using a standard protocol. They were closely followed up for need for change in antibiotics, prolonged hospital stay, need for mechanical ventilation and mortality. Data on the factors influencing the outcome were collected. Of 200 children enrolled in the study, 113 (56.5%) needed a change in antibiotics, 102 (51%) stayed for more than 5 days in the hospital, 41 (20.5%) needed mechanical ventilation and 21 (10.5%) died. On multivariate analysis, lack of exclusive breastfeeding [RR (95%CI) 2.63 (2.16–2.86)], overcrowding [RR (95%CI) 1.94 (1.35–2.38)] and an abnormal chest x-ray [RR (95%CI) 2.29 (1.22–3.44)] were associated with the need for change of antibiotics. Lack of exclusive breastfeeding [RR (95%CI) 2.56 (2.0–2.93)], overcrowding [RR (95%CI) 2.59 (1.78–3.23)] and an abnormal chest x-ray [RR (95%CI) 2.99 (1.65–4.38)] were identified as determinants for prolonged hospital stay. Head nodding [RR (95%CI) 8.34 (2.71–12.77)], altered sensorium [RR (95%CI) 5.44 (1.34–17.56)], abnormal leukocyte counts [RR (95%CI) 5.85(1.36–17.14)] and pallor [RR (95%C) 10.88 (2.95–20.40)] were associated with mortality. Head nodding (RR (95% CI) 4.73 (1.50–6.36)] and cyanosis (RR (95%CI) 5.06 (1.80–11.34)] were the determining factors for mechanical ventilation. In radiographically confirmed pneumonia, the determining factors for change of antibiotics were: lack of exclusive breast feeding [RR (95% CI) 2.05 (1.69–2.2)] and low birth weight [RR (95% CI) 1.59 (1.1–1.89)]. For prolonged hospital stay, the factors identified were mothers' education less than graduation [RR (95% CI) 1.5 (1.19–1.7)], lack of exclusive breast feeding [RR (95% CI) 1.77 (1.19–2.09)] and oxygen saturation of < 90% at time of presentation [RR (95% CI) 2.06 (1.42–2.42)]. Determinants for mechanical ventilation were mothers' education less than graduation [RR (95% CI) 3.6 (1.15–6.3)] and cyanosis at presentation [RR (95% CI) 10.9 (1.56–18.9)]. For mortality, the only determinant was pallor [RR (95% CI) 10.54 (1.8–21.79)]. Children hospitalized with severe community acquired pneumonia [as defined by World Health Organization (WHO)] who had not received exclusive breast feeding, had stayed in an overcrowded homes and had an abnormal chest radiograph were more likely to fail to respond with primary antibiotic regimen and require change of antibiotics and prolonged hospital stay. In children with radiographically confirmed pneumonia, lack of breast feeding and low birth weight was associated with need for change in antibiotics.
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影响因子：
--
作者：
Banajeh, SM;AlSunbali, NN;AlSanahani, SH
通讯作者：
AlSanahani, SH
影响因子：
5
作者：
Coles, CL;Fraser, D;Dagan, R
通讯作者：
Dagan, R
DOI：
10.1136/adc.64.7_spec_no.930
发表时间：
1989-07-01
影响因子：
4.4
作者：
JAIN, L;VIDYASAGAR, D;BLEND, M
通讯作者：
BLEND, M
影响因子：
5.2
作者：
Bruinsma, N;Hutchinson, JM;Stobberingh, EE
通讯作者：
Stobberingh, EE
影响因子：
4.3
作者：
Jain, Neemisha;Lodha, R.;Kabra, S. K.
通讯作者：
Kabra, S. K.