Chest Indrawing Research Articles

Risk Factors for Acute Respiratory Infections in Children Between 0 and 23 Months of Age in a Peri-Urban District in Pakistan: A Matched Case-Control Study.

Background: Acute respiratory infection (ARI) accounts for nearly 15% of all childhood mortality in South Asia, with children from rural areas at higher risk due to inaccessibility to healthcare facilities. We therefore aimed to identify risk factors associated with ARI in children under 2 years of age in rural Pakistan.Methods: A retrospective 1:2 matched case–control study was conducted between October and December 2018 in Taluka Kotri, Jamshoro District of Pakistan. Cases were identified as children between 0 and 23 months of age with a history of fever, cough, sore throat, fast breathing, difficulty breathing, or chest indrawing in the 2 weeks prior to the survey. Controls were participants without symptoms of ARI, matched based on age in months. Data analysis was conducted using STATA version 15. Univariate and multivariable conditional logistic regression analyses were used to identify factors associated with ARI, and p < 0.05 was considered statistically significant.Results: We identified 1,071 cases of ARI who were matched with 2,142 controls. Multivariable analysis revealed that female gender [odds ratio (OR) 0.78, 95% confidence interval (CI): 0.67–0.91], exclusive breastfeeding (OR 0.81, 95% CI: 0.69–0.97), and comorbidity with diarrhea (OR: 1.64, 95% CI: 1.40–1.91) were significantly associated with ARI.Conclusion: Pakistan continues to progress toward reducing childhood mortality, particularly ARI-related deaths, for which it bears a great burden. This study identifies risk factors such as the male gender, breastfeeding, and comorbidities with diarrhea, which could open grounds for further programmatic implications in targeting a multifaceted approach to reducing incidences of ARI in rural areas of the country.

Innovative, enhanced community management of non-hypoxaemic chest-indrawing pneumonia in 2–59-month-old children: a cluster-randomised trial in Africa and Asia

IntroductionThe WHO recommends oral amoxicillin for 2–59-month-old children with chest-indrawing pneumonia presenting at the health facility. Community-level health workers (CLHWs) are not allowed to treat these children when presented at...

Importance of respiratory syncytial virus as a predictor of hospital length of stay in bronchiolitis.

IIntroduction : Bronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease. This study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income country Methods: We conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted to the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variables Results : The median of the length of hospital stay was 3.68 days, with a range of 0.74 days to 29 days, 138 (33.17%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age <6 months, comorbidities (CHD or neurological), BPD, chest indrawing, RSV isolation, and C-reactive protein were independent predictors of LOS Conclusions : Our results show that in infants with bronchiolitis, RSV isolation, age <6 months, comorbidities (CHD or neurological), BPD, chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the high medical cost associates with prolonged LOS in bronchiolitis.

CLINICAL PROFILE OF NEONATES WITH RESPIRATORY DISTRESS

Background: To study the clinical profile of neonates with respiratory distress.&#x0D; Methods: A prospective study was conducted on 100 cases. Term, pre-term and post-term babies both in-borns and out-borns cases were included in the study.&#x0D; Results: The majority of cases 85.00% presented with increased respiratory rate, chest in drawings. 85.00% babies had flaring of alae nasi.&#x0D; Conclusion: Increased respiratory rate along with chest in drawing, flaring of alae nasi are the presentation of RD in majority of cases.&#x0D; Keywords: Respiratory distress, Clinical profile, Tachypnea

Role of Clinical Criteria and Oxygen Saturation Monitoring in Diagnosis of Childhood Pneumonia in Children Aged 2 to 59 Months

Current WHO algorithm has retained the signs and symptoms used in the older version for classifying severity of childhood pneumonia. To study the role of clinical features (including that of current WHO criteria), and oxygen saturation (SpO2) in the diagnosis of childhood pneumonia. Multicenter prospective cohort study. Children, 2 to 59 months of age, suffering from acute respiratory infection (ARI). Sensitivity, specificity, and likelihood ratios were calculated for clinical features, and SpO2. Of a total 7026 children with ARI enrolled, 13.4% had pneumonia (37% of them had severe pneumonia), according to WHO criteria. Based on any abnormality on chest x ray (CXR), 46% had pneumonia. The sensitivity and specificity of the existing WHO criteria for diagnosis of pneumonia was 56.5% and 66.2%, respectively, when compared against abnormalities in CXR. Cough and fever, each had sensitivity of >80%. Audible wheeze and breathing difficulty, each had a specificity of >80%. Sensitivity and specificity of tachypnoea were 58.7% and 63.3%, respectively. None of the clinical features alone had a sensitivity and specificity of >80%. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increased the likelihood of diagnosis of pneumonia. Current WHO criteria based on rapid respiratory rate and/or chest indrawing has modest sensitivity and specificity, considering CXR abnormalities as gold standard for diagnosis of pneumonia. Addition of SpO2 of <92% to chest indrawing alone or WHO criteria increases the probability of pneumonia diagnosis, and is important in the management of a child with pneumonia.

Video based non-contact monitoring of respiratory rate and chest indrawing in children with pneumonia

Objective. Pneumonia is the single largest cause of death in children worldwide due to infectious diseases. According to WHO guidelines, fast breathing and chest indrawing are the key indicators of pneumonia in children requiring antibiotic treatments. The aim of this study was to develop a video based novel method for simultaneous monitoring of respiratory rate and chest indrawing without upsetting babies. Approach. Respiratory signals, corresponding to periodic movements of chest-abdominal walls during breathing, were extracted by analyzing RGB (red, green, blue) components in video frames captured by a smartphone camera. Respiratory rate was then obtained by applying fast Fourier transform on the de-noised respiratory signal. Chest indrawing was detected by analysing relative phases of regional chest-abdominal wall mobility. The performance of the developed algorithm was evaluated on both healthy and pneumonia children. Main results. The proposed method can measure respiratory rate with an overall mean absolute error of 1.8 bpm in the range 18–105 bpm. Phase difference between regional chest wall movements in the chest indrawing (pneumonia) cases was found to be 143 ± 23.9 degrees, which was significantly higher than that in the healthy cases 52.3 ± 32.6 degrees (p < 0.001). Significance. Being non-intrusive and non-subjective, this computer-aided method can be useful in the monitoring for respiratory rate and chest indrawing for the diagnosis of pneumonia and its severity in children.

Predicting the risk of mortality during hospitalization in sick severely malnourished children using daily evaluation of key clinical warning signs

BackgroundDespite adherence to WHO guidelines, inpatient mortality among sick children admitted to hospital with complicated severe acute malnutrition (SAM) remains unacceptably high. Several studies have examined risk factors present at admission for mortality. However, risks may evolve during admission with medical and nutritional treatment or deterioration. Currently, no specific guidance exists for assessing daily treatment response. This study aimed to determine the prognostic value of monitoring clinical signs on a daily basis for assessing mortality risk during hospitalization in children with SAM.MethodsThis is a secondary analysis of data from a randomized trial (NCT02246296) among 843 hospitalized children with SAM. Daily clinical signs were prospectively collected during ward rounds. Multivariable extended Cox regression using backward feature selection was performed to identify daily clinical warning signs (CWS) associated with time to death within the first 21 days of hospitalization. Predictive models were subsequently developed, and their prognostic performance evaluated using Harrell’s concordance index (C-index) and time-dependent area under the curve (tAUC).ResultsInpatient case fatality ratio was 16.3% (n=127). The presence of the following CWS during daily assessment were found to be independent predictors of inpatient mortality: symptomatic hypoglycemia, reduced consciousness, chest indrawing, not able to complete feeds, nutritional edema, diarrhea, and fever. Daily risk scores computed using these 7 CWS together with MUAC<10.5cm at admission as additional CWS predict survival outcome of children with SAM with a C-index of 0.81 (95% CI 0.77–0.86). Moreover, counting signs among the top 5 CWS (reduced consciousness, symptomatic hypoglycemia, chest indrawing, not able to complete foods, and MUAC<10.5cm) provided a simpler tool with similar prognostic performance (C-index of 0.79; 95% CI 0.74–0.84). Having 1 or 2 of these CWS on any day during hospitalization was associated with a 3 or 11-fold increased mortality risk compared with no signs, respectively.ConclusionsThis study provides evidence for structured monitoring of daily CWS as recommended clinical practice as it improves prediction of inpatient mortality among sick children with complicated SAM. We propose a simple counting-tool to guide healthcare workers to assess treatment response for these children.Trial registrationNCT02246296

CLINICAL PROFILE OF NEONATES WITH RESPIRATORY DISTRESS

Background: Respiratory distress (RD) is a challenging problem and is one of the most common causes of admission in neonatal intensive care unit (NICU).&#x0D; Methods: A prospective study was conducted on 50 cases. Term, pre-term and post-term babies both in-borns and out-borns cases were included in the study.&#x0D; Results: Of the 50 cases admitted with RD, 31 babies (62%) were delivered vaginally and 19 (38%) by lower segment caesarean section (LSCS). There were 33 (66%) males and 17 (34%) females in the study. There were 23 (46%) pre-term babies, 26 (52%) term and 1 (2%) post-term neonates who were admitted with RD. The majority of cases 42 (82%) presented with increased respiratory rate, chest in drawings. 41 (82%) babies had flaring of alae nasi.&#x0D; Conclusion: Increased respiratory rate along with chest in drawing, flaring of alae nasi are the presentation of RD in majority of cases.&#x0D; Keywords: Respiratory distress (RD), Flaring of alae nasi are, Tachypnea.

Repeat assessment of physical examination findings among HIV-uninfected children in Malawi with chest-indrawing pneumonia: Recto: Chest-indrawing pneumonia in HIV-uninfected

Despite its high burden and deadly consequences, pediatric pneumonia is difficult to diagnose and the prognosis is difficult to predict, particularly in resource-constrained settings. The World Health Organization (WHO) recommends that pediatric pneumonia be diagnosed based on clinical signs and symptoms such as cough, difficulty breathing, fast breathing, chest indrawing, and danger signs using the Integrated Management of Childhood Illnesses (IMCI) guidelines. (World Health Organization (WHO) 2014) However, diagnosing pneumonia based on subjective, non-specific and unreliable signs and symptoms can prove challenging.

Importance of respiratory syncytial virus as a predictor of hospital length of stay in bronchiolitis

Introduction: Bronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease. This study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income country Methods: We conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted to the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variables Results: The median of the length of hospital stay was 3.68 days, with a range of 0.74 days to 29 days, 138 (33.17%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age &lt;6 months, comorbidities (CHD or neurological), BPD, chest indrawing, RSV isolation, and C-reactive protein were independent predictors of LOS Conclusions: Our results show that in infants with bronchiolitis, RSV isolation, age &lt;6 months, comorbidities (CHD or neurological), BPD, chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the high medical cost associates with prolonged LOS in bronchiolitis.

Clinical signs of possible serious infection and associated mortality among young infants presenting at first-level health facilities.

The World Health Organization recommends inpatient hospital treatment of young infants up to two months old with any sign of possible serious infection. However, each sign may have a different risk of death. The current study aims to calculate the case fatality ratio for infants with individual or combined signs of possible serious infection, stratified by inpatient or outpatient treatment. We analysed data from the African Neonatal Sepsis Trial conducted in five sites in the Democratic Republic of the Congo, Kenya and Nigeria. Trained study nurses classified sick infants as pneumonia (fast breathing in 7-59 days old), severe pneumonia (fast breathing in 0-6 days old), clinical severe infection [severe chest indrawing, high (> = 38°C) or low body temperature (<35.5°C), stopped feeding well, or movement only when stimulated] or critical illness (convulsions, not able to feed at all, or no movement at all), and referred them to a hospital for inpatient treatment. Infants whose caregivers refused referral received outpatient treatment. The case fatality ratio by day 15 was calculated for individual and combined clinical signs and stratified by place of treatment. An infant with signs of clinical severe infection or severe pneumonia was recategorised as having low- (case fatality ratio ≤2%) or moderate- (case fatality ratio >2%) mortality risk. Of 7129 young infants with a possible serious infection, fast breathing (in 7-59 days old) was the most prevalent sign (26%), followed by high body temperature (20%) and severe chest indrawing (19%). Infants with pneumonia had the lowest case fatality ratio (0.2%), followed by severe pneumonia (2.0%), clinical severe infection (2.3%) and critical illness (16.9%). Infants with clinical severe infection had a wide range of case fatality ratios for individual signs (from 0.8% to 11.0%). Infants with pneumonia had similar case fatality ratio for outpatient and inpatient treatment (0.2% vs. 0.3%, p = 0.74). Infants with clinical severe infection or severe pneumonia had a lower case fatality ratio among those who received outpatient treatment compared to inpatient treatment (1.9% vs. 6.5%, p<0.0001). We recategorised infants into low-mortality risk signs (case fatality ratio ≤2%) of clinical severe infection (high body temperature, or severe chest indrawing) or severe pneumonia and moderate-mortality risk signs (case fatality ratio >2%) (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection). We found that both categories had four times lower case fatality ratio when treated as outpatient than inpatient treatment, i.e., 1.0% vs. 4.0% (p<0.0001) and 5.3% vs. 22.4% (p<0.0001), respectively. In contrast, infants with signs of critical illness had nearly two times higher case fatality ratio when treated as outpatient versus inpatient treatment (21.7% vs. 12.1%, p = 0.097). The mortality risk differs with clinical signs. Young infants with a possible serious infection can be grouped into those with low-mortality risk signs (high body temperature, or severe chest indrawing or severe pneumonia); moderate-mortality risk signs (stopped feeding well, movement only when stimulated, low body temperature or multiple signs of clinical severe infection), or high-mortality risk signs (signs of critical illness). New treatment strategies that consider differential mortality risks for the place of treatment and duration of inpatient treatment could be developed and evaluated based on these findings. This trial was registered with the Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.

The role of body temperature on respiratory rate in children with acute respiratory infections.

The World Health Organization (WHO) recommends the use of tachypnea as a proxy to the diagnosis of pneumonia. The purpose of this study was to examine the relationship between body temperature alterations and respiratory rate (RR) difference (RRD) in children with acute respiratory infections(ARI). This cross-sectional study included 297 children with age 2-60 months who presented with cough and fever at the pediatric emergency and outpatient clinics in the Department of Pediatrics, Baskent University Hospital, from January 2016 through June 2018. Each parent completed a structured questionnaire to collect background data. Weight and height were taken. Body temperature, respiratory rate, presence of the chest indrawing, rales, wheezing and laryngeal stridor were also recorded. RRD was defined as the differences in RR at admission and after 3 days of treatment. Both respiratory rate and RRD were moderately correlated with body temperature (r=0.71, p<0.001 and r=0.65, p<0.001; respectively). For every 1°C increase in temperature, RRD increased by 5.7/minutes in overall, 7.2/minute in the patients under 12 months of age, 6.4/minute in the female. The relationship between body temperature and RRD wasn't statistically significant in patients with rhonchi, chest indrawing, and low oxygen saturation. Respiratory rate should be evaluated according to the degree of body temperature in children with ARI. However, the interaction between body temperature and respiratory rate could not be observed in cases with rhonchi and severe pneumonia.

Knowledge of danger signs in neonates among postnatal mothers of babies admitted in tertiary care neonatal intensive care unit in a two-tier town in South India

Background: Neonatal period is the first 28 days of life. Neonatal period is highly vulnerable and has high risk of mortality at an average global rate of 17/1000. Neonatal illnesses present with non-specific symptoms and signs. Neonatal danger signs signify common signs of severe illness. Aim of the study was to assess the awareness of postnatal mothers about danger signs in neonates and the associated factors.Methods: Facility based cross sectional study conducted at a tertiary care hospital in a two-tier town in South India. Source of population was postnatal mothers of babies who were admitted in NICU. A structured questionnaire was used to collect the data through face-to-face interview. Neonatal danger signs are signs that sick neonates show as stated by WHO, which includes- not able to feed, or stopped feeding well, convulsed or fitted since birth, fast breathing, chest in drawing, fever, cold to touch, yellow palms and soles, umbilical redness, or draining of pus, skin boils, or eyes draining pus, no or minimal movement when stimulated. Mothers who mentioned at least 3 are considered to have good knowledge.Results: Commonly mentioned danger signs are fever (89%), chest indrawing (59%), poor feeding (51%), and umbilical redness (48%). Mothers who had good knowledge was 32% of which 75.9% had counselling on danger signs during antenatal visits, 78% had antenatal visits more than 4,86.9% had post-natal care or visits,51.56% had education above secondary school.Conclusions: Mothers need counselling on neonatal danger signs during antenatal and post-natal visits to reduce neonatal mortality.

Survival and predictors of mortality among severe acute malnourished under-five children admitted at Felege-Hiwot comprehensive specialized hospital, northwest, Ethiopia: a retrospective cohort study

BackgroundMalnutrition is still a global public health problem contributing for under-five morbidity and mortality. The case is similar in Ethiopia in which severe acute malnutrition is the major contributor to mortality being an underlying cause for nearly 45% of under-five deaths. However, there is no recent evidence that shows the time to death and public health importance of oxygen saturation and chest in drawing in the study area. Therefore, estimated time to death and its predictors can provide an input for program planners and decision-makers.MethodsA facility -based retrospective cohort study was conducted among 488 severe acute malnourished under-five children admitted from the 1st of January 2016 to the 30th of December 2019. The study participants were selected by using simple random sampling technique. Data were entered in to Epi-Data version 3.1 and exported to STATA version15 statistical software for further analysis. The Kaplan Meier was used to estimate cumulative survival probability and a log-rank test was used to compare the survival time between different categories of explanatory variables. The Cox-proportional hazard regression model was fitted to identify predictors of mortality. P-value< 0.05 was used to declare statistical significance.ResultsOut of the total 488 randomly selected charts of children with severe acute malnutrition, 476 records were included in the final analysis. A total of 54(11.34%) children died with an incidence rate of 9.1death /1000 person- days. Failed appetite test (AHR: 2.4; 95%CI: 1.26, 4.67), altered consciousness level at admission (AHR: 2.4; 95%CI: 1.08, 4.67), oxygen saturation below 90% (AHR: 3.3; 95%CI: 1.40, 7.87), edema (AHR 2.9; 95%CI: 1.45, 5.66) and HIV infection (AHR: 2.8; 95%CI: 1.24, 6.36) were predictors of mortality for children diagnosed with severe acute malnutrition.ConclusionThe overall survival status of severe acute malnourished children was low as compared to national sphere standards and previous reports in the literature. The major predictors of mortality were oxygen saturation below 90%, altered consciousness, HIV infection, edema and failed appetite test. Therefore, early screening of complications, close follow up and regular monitoring of sever acute malnourished children might improve child survival rate.

Serial lung ultrasounds in pediatric pneumonia in Mozambique and Pakistan

Lung ultrasound (LUS) is a promising point-of-care imaging technology for diagnosing and managing pneumonia. We sought to explore serial LUS examinations in children with chest-indrawing pneumonia in resource-constrained settings and compare their clinical and LUS imaging courses longitudinally. We conducted a prospective, observational study among children aged 2 through 23 months with World Health Organization Integrated Management of Childhood Illness chest-indrawing pneumonia and among children without fast breathing, chest indrawing or fever (no pneumonia cohort) at 2 district hospitals in Mozambique and Pakistan. We assessed serial LUS at enrollment, 2, 6, and 14 days, and performed a secondary analysis of enrolled children’s longitudinal clinical and imaging courses. By Day 14, the majority of children with chest-indrawing pneumonia and consolidation on enrollment LUS showed improvement on follow-up LUS (100% in Mozambique, 85.4% in Pakistan) and were clinically cured (100% in Mozambique, 78.0% in Pakistan). In our cohort of children with chest-indrawing pneumonia, LUS imaging often reflected the clinical course; however, it is unclear how serial LUS would inform the routine management of non-severe chest-indrawing pneumonia.

Importance of respiratory syncytial virus as a predictor of hospital length of stay in bronchiolitis.

Introduction: Bronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease. This study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income country Methods: We conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted to the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variables Results: The median of the length of hospital stay was 3.68 days, with a range of 0.74 days to 29 days, 138 (33.17%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age <6 months, comorbidities (CHD or neurological), BPD, chest indrawing, RSV isolation, and C-reactive protein were independent predictors of LOS Conclusions: Our results show that in infants with bronchiolitis, RSV isolation, age <6 months, comorbidities (CHD or neurological), BPD, chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the high medical cost associates with prolonged LOS in bronchiolitis.

Bacterial infection in wheezy children.

Objective: To determine the frequency of bacterial infection in children less than five years of age presenting with respiratory wheeze to Tertiary care centre. Study Design: Descriptive Case Series study. Setting: Department of Pediatrics, The Children’s Hospital and The Institute of Child Health, Multan. Period: November 2019 to April 2020. Material &amp; Methods: A total of 130 children, presenting with respiratory symptoms were examined for presence of respiratory wheeze. After confirmation of chest auscultation, patients were enrolled. Information regarding duration of wheeze, axillary temperature, presence of chest in drawing and respiratory rate were recorded. Appropriate blood sample were drawn for total leukocyte count and differential leukocyte count from which absolute neutrophils count was calculated. Children were evaluated for the presence of bacterial infection as per operational definition. Results: There were 38 (29.23%) female and 92 (70.76%) male patients. Overall, mean age was13.17±5.49 with age range of 1-57 months. Bacterial infection was noted in 33 (25.38%) patients. Out of 130 patients presenting with wheeze, 50 patients (38.46%) had temperature range of 98.1-990F. Absolute neutrophil count was more than 5000/dl in 42(32.30%) patients, out of these 33(78.6%) had bacterial infection. Chest X-rays were showing infiltrates in 110 (84.6%) patients. Conclusion: Children suffering from wheeze have bacterial infection if age is less than five years and there is fever, crepitations, elevated absolute neutrophil count and radiographic evidence of pneumonia.

CLINICAL PROFILE OF NEONATES WITH RESPIRATORY DISTRESS

Background: To study the clinical profile of neonates with respiratory distress.&#x0D; Methods: A prospective study was conducted on 50 cases. Term, pre-term and post-term babies both in-borns and out-borns cases were included in the study.&#x0D; Results: The majority of cases 43 (86.00%) presented with increased respiratory rate, chest in drawings. 42 (84%) babies had flaring of alae nasi.&#x0D; Conclusion: Increased respiratory rate along with chest in drawing, flaring of alae nasi are the presentation of RD in majority of cases.&#x0D; Keywords: Respiratory distress (RD), Clinical profile, Tachypnea

Prevalence of Pneumonia Severity in Children under 5 Years Old at Primary Health Care of Tambakrejo, Surabaya

Introduction: Pneumonia is the world-leading cause of death in children under five years old and most prevalent in developing country. Proper initial diagnosis will determine further management, because pneumonia and severe pneumonia have different treatment. The aim of this study was to describe the prevalence of pneumonia severity in children under five years old at primary health setting. Methods: This study was a cross – sectional descriptive study on medical records of children aged 2 to 59 months with pneumonia at primary health care of Tambakrejo, Surabaya from September to December 2017. Severity of pneumonia is classified using its clinical sign such as fast breathing, fever, chest indrawing, and general danger sign. The data were processed using Microsoft Office Excel and statistically analyzed with SPSS IBM 20. Results: There were 31 respondents that were diagnosed with pneumonia at primary health care of Tambakrejo, Surabaya from September to December 2017. Most of the children diagnosed with pneumonia were aged 12 to 59 months (61.3%) and 22.6 % of the children had severe pneumonia. Conclusion: Distribution of severity case of pneumonia at primary health care of Tambakrejo, Surabaya showed that there were more case of pneumonia with fast breathing than severe pneumonia or pneumonia with any general danger sign. Most of them were diagnosed at 12 to 59 months with a good nutritional status.

Antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze.

Worldwide, pneumonia is the leading cause of death amongst children under five years of age, and accounts for approximately two million deaths annually. Pneumonia can be classified according to the World Health Organization (WHO) guidelines. Classification includes assessment of certain clinical signs and symptoms, and the severity of the disease. Treatment is then tailored according to the classification. For non-severe pneumonia, the WHO recommends treatment with oral antibiotics. We used the 2014 WHO definition of non-severe pneumonia for this review: an acute episode of cough, or difficulty in breathing, combined with fast breathing and chest indrawing. The WHO recommends treating non-severe pneumonia with oral antibiotics. Pneumonia is more commonly caused by viruses that do not require antibiotic treatment, but pneumonia caused by bacteria needs management with antibiotics to avoid complications. There is no clear way to quickly distinguish between viral and bacterial pneumonia. It is considered safe to give antibiotics, however, this may lead to the development of antibiotic resistance, and thus, limit their use in future infections. Therefore, it is essential to explore the efficacy of antibiotics for children with WHO-defined non-severe pneumonia and wheeze. To evaluate the efficacy of antibiotic therapy versus no antibiotic therapy for children aged 2 to 59 months with WHO-defined non-severe pneumonia and wheeze. We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registers (December 2020). We included randomised controlled trials (RCTs) evaluating the efficacy of antibiotic therapy versus no antibiotic therapy for children, aged 2 to 59 months, with non-severe pneumonia and wheeze. We defined non-severe pneumonia as 'a cough or difficulty in breathing, with rapid breathing (a respiratory rate of 50 breaths per minute or more for children aged 2 to 12 months, or a respiratory rate of 40 breaths per minute or more for children aged 12 to 59 months), chest indrawing and wheeze'. We excluded trials involving children with severe or very severe pneumonia, and non-RCTs. Our primary outcomes were clinical cure and treatment failure; secondary outcomes were relapse, mortality, and treatment harms. We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. Two review authors independently assessed the search results, extracted data, assessed risk of bias and the certainty of the evidence. We contacted the authors of two included trials and the author of the trial awaiting classification to obtain missing numerical outcome data. We included three trials involving 3256 children aged between 2 to 59 months, who exhibited features of non-severe pneumonia with wheeze. The included trials were multi-centre, double-blind, randomised, placebo-controlled trials carried out in Malawi, Pakistan, and India. The children were treated with a three-day course of amoxicillin or placebo, and were followed up for a total of two weeks. We assessed the included trials at overall low risk of bias for random sequence generation, allocation concealment, blinding, attrition bias, and selective reporting. Only one trial was assessed to be at high risk for blinding of outcome assessors. One trial is awaiting classification Antibiotic therapy may result in a reduction of treatment failure by 20% (risk ratio (RR) 0.80, 95% confidence interval (CI) 0.68 to 0.94; three trials; 3222 participants; low-certainty evidence). Antibiotic therapy probably results in little or no difference toclinical cure (RR 1.02, 95% CI 0.96 to 1.08; one trial; 456 participants; moderate-certainty evidence), and in little or no difference to relapse (RR 1.00, 95% CI 0.74 to 1.34; three trials; 2795 participants; low-certainty evidence), and treatment harms (RR 0.81, 95% CI 0.60 to 1.09; three trials, 3253 participants; low-certainty evidence). Two trials (2112 participants ) reported on mortality; no deaths occurred in either group. One trial reported cases of hospitalisation, diarrhoea (with and without dehydration), rash (without itch), tremors, mild nausea and vomiting. We do not currently have enough evidence to support or challenge the continued use of antibiotics for the treatment of non-severe pneumonia. There is a clear need for RCTs to address this question in children aged 2 to 59 months with 2014 WHO-defined non-severe pneumonia and wheeze.