Chest Indrawing Research Articles

Care seeking for childhood pneumonia by rural and poor urban communities in Lucknow: A community-based cross-sectional study.

Context:Globally, around 16% of under-five children die due to pneumonia. Childhood pneumonia, if identified early is a readily treatable through low-cost antibiotics. Access to timely and appropriate care is a key action to control pneumonia.Aims:The aim of the study was to understand the caregiver's care-seeking behavior for the management of childhood pneumonia among rural and urban poor communities in Lucknow.Settings and Design:Rural areas and urban slums of Lucknow district, from September 2014 to August 2015.Subjects and Methods:A community-based cross-sectional study. Total of 1065 under-five children were selected by multistage random sampling method. Caregivers of children (<5 years of age) were interviewed through pretested, semi-structured interview schedule. Information was gathered on episode of cough, difficult breathing, and or chest indrawing in child within 2 weeks preceding the survey, and caregiver's treatment seeking practices.Results:Out of total 1065 children, 52 (%) had pneumonia within 2 weeks preceding the survey. At the onset of illness, difficult/fast breathing was identified by 86.5% caregivers, but majority of them did not perceive it as a serious condition and resort to home remedies. Only 9.6% sought appropriate care at onset of illness. Appearance of chest indrawing in the child was identified by caregivers as a serious condition and sought treatment from outside. The mean time taken from onset of illness to the seeking care from health facility was around 2½ days (2.39 ± 0.75). Qualified private practitioners (70.5%) were the preferred choice and majority (87.0%) of the children received antibiotic for pneumonia. However, even after perception of seriousness of the illness, 26.8% and 11.1% caregivers in urban slums and rural areas, respectively sought inappropriate care at the first consultation.Conclusions:Caregivers were unable to perceive the severity of fast breathing leading to the delayed initiation of the appropriate treatment. There is a need of community mobilization through behavior change communication interventions to promote early symptom recognition and appropriate care seeking for pneumonia.

Treatment Failure of Ampicillin to Children with Pneumonia at Dr. Hasan Sadikin General Hospital Bandung from 2014–2015

Background : Pneumonia is one of the causes of death in infants in developing countries especially Indonesia. Appropriate treatment is needed to decrease mortality rate in children due to pneumonia. Ampicillin is one of first choices empirical antibiotic to children with severe pneumonia. The study was aimed to determine the failure rate of ampicillin in children with severe pneumonia. Methods : This study was a descriptive study which used medical records as source of data. Subjects were children aged 2–59 months with World Health Organization (WHO) defined with severe pneumonia and treated with intravenous ampicillin during January 2014 to July 2015 at Dr. Hasan Sadikin General Hospital Bandung. Samples were obtained using total sampling method while variables were analyzed using statistics software. Results : This study acquired 107 patients who met the inclusion criteria with 23.36% of them aged 2–11 months and 62.21% aged 12–23 months. Majority of subjects were male amounted as 63.55% while female occupied 36.45%. Treatment failure on the third day was 45.8% while 16.7% on the sixth day of therapy with majority failure due to existence of lower chest indrawing. Conclusions : Treatment failure on the third and sixth day of therapy still high that is characterized by the existence of lower chest indrawing as its main factor. [AMJ.2017;4(1):100–6] DOI: 10.15850/amj.v4n1.1029

Zinc supplementation for the prevention of pneumonia in children aged 2 months to 59 months.

Pneumonia is a leading cause of morbidity and mortality in children younger than five years of age. Most deaths occur during infancy and in low-income countries. Daily zinc supplements have been reported to prevent acute lower respiratory tract infection (LRTI) and reduce child mortality. This is an update of a review first published in 2010. To evaluate the effectiveness of zinc supplementation in the prevention of pneumonia in children aged two to 59 months. We searched CENTRAL (Issue 21 October 2016), MEDLINE (1966 to October 2016), Embase (1974 to October 2016), LILACS (1982 to October 2016), CINAHL (1981 to October 2016), Web of Science (1985 to October 2016) and IMSEAR (1980 to October 2016). Randomised controlled trials (RCTs) evaluating zinc supplementation for the prevention of pneumonia in children aged from 2 months to 59 months. Two review authors independently assessed trial quality and extracted data. We did not identify any new studies for inclusion in this update. We included six studies that involved 5193 participants.Analysis showed that zinc supplementation reduced the incidence of pneumonia by 13% (fixed-effect risk ratio (RR) 0.87; 95% confidence interval (CI) 0.81 to 0.94, six studies, low-quality evidence) and prevalence of pneumonia by 41% (random-effects RR 0.59; 95% CI 0.35 to 0.99, one study, n = 609, low-quality evidence). On subgroup analysis, we found that zinc reduced the incidence of pneumonia defined by specific clinical criteria by 21% (i.e. confirmation by chest examination or chest radiograph) (fixed-effect RR 0.79; 95% CI 0.0.71 to 0.88, four studies, n = 3261), but had no effect on lower specificity pneumonia case definition (i.e. age-specific fast breathing with or without lower chest indrawing) (fixed-effect RR 0.95; 95% CI 0.86 to 1.06, four studies, n = 1932). Zinc supplementation in children is associated with a reduction in the incidence and prevalence of pneumonia.

Clinical Profile and Outcome of Pneumonia in Children

Pneumonia is one of the largest killers of children under five years of age around the world. The present study was done to study the clinical features, outcome, bacteriological profile and radiological features of pneumonia in children. This was a descriptive study of pneumonia conducted on 100 children in the age group of 1 month to 12 years, with clinical features of tachypnoea as per WHO criteria and chest indrawing, who got admitted in pediatric wards of Rajah Muthiah Medical college, Annamalai University, Chidambaram during November 2014 to August 2016.Study showed that 82% of the children belonged to the age group of 1-month - 5year, male to female ratio was 1.17:1. Rapid breathing/ respiratory distress (100%), cough (100%) and fever (99%) were the most common symptoms. Refusal of feeds was present in 24% cases. Tachypnoea (100%), chest retractions (100%) and crepitations (82%) were the most common signs. Diarrhoea (7%), meningitis(3%) ,CCF(1%)were the associated illness. 71% were breast-fed and 29% were given bottle feeds. 55% were anemic. 62% had grade 1 and 2, 30% had grade 3 and 4 PEM. From the study, it was concluded that pneumonia is one of the major causes of morbidity and mortality in children. Blood culture will not give much information regarding etiology of pneumonia. Chest X-ray is valuable aid in the diagnosis of pneumonia in children.

Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi.

ObjectiveTo investigate implementation of outpatient pulse oximetry among children with pneumonia, in Malawi.MethodsIn 2011, 72 health-care providers at 18 rural health centres and 38 community health workers received training in the use of pulse oximetry to measure haemoglobin oxygen saturations. Data collected, between 1 January 2012 and 30 June 2014 by the trained individuals, on children aged 2–59 months with clinically diagnosed pneumonia were analysed.FindingsOf the 14 092 children included in the analysis, 13 266 (94.1%) were successfully checked by oximetry. Among the children with chest indrawing and/or danger signs, those with a measured oxygen saturation below 90% were more than twice as likely to have been referred as those with higher saturations (84.3% [385/457] vs 41.5% [871/2099]; P < 0.001). The availability of oximetry appeared to have increased the referral rate for severely hypoxaemic children without chest indrawing or danger signs from 0% to 27.2% (P < 0.001). In the absence of oximetry, if the relevant World Health Organization (WHO) guidelines published in 2014 had been applied, 390/568 (68.7%) severely hypoxaemic children at study health centres and 52/84 (61.9%) severely hypoxaemic children seen by community health workers would have been considered ineligible for referral.ConclusionImplementation of pulse oximetry by our trainees substantially increased the referrals of Malawian children with severe hypoxaemic pneumonia. When data from oximetry were excluded, retrospective application of the guidelines published by WHO in 2014 failed to identify a considerable proportion of severely hypoxaemic children eligible only via oximetry.

Predicting Severe Pneumonia Outcomes in Children

Substantial morbidity and excessive care variation are seen with pediatric pneumonia. Accurate risk-stratification tools to guide clinical decision-making are needed. We developed risk models to predict severe pneumonia outcomes in children (<18 years) by using data from the Etiology of Pneumonia in the Community Study, a prospective study of community-acquired pneumonia hospitalizations conducted in 3 US cities from January 2010 to June 2012. In-hospital outcomes were organized into an ordinal severity scale encompassing severe (mechanical ventilation, shock, or death), moderate (intensive care admission only), and mild (non-intensive care hospitalization) outcomes. Twenty predictors, including patient, laboratory, and radiographic characteristics at presentation, were evaluated in 3 models: a full model included all 20 predictors, a reduced model included 10 predictors based on expert consensus, and an electronic health record (EHR) model included 9 predictors typically available as structured data within comprehensive EHRs. Ordinal regression was used for model development. Predictive accuracy was estimated by using discrimination (concordance index). Among the 2319 included children, 21% had a moderate or severe outcome (14% moderate, 7% severe). Each of the models accurately identified risk for moderate or severe pneumonia (concordance index across models 0.78-0.81). Age, vital signs, chest indrawing, and radiologic infiltrate pattern were the strongest predictors of severity. The reduced and EHR models retained most of the strongest predictors and performed as well as the full model. We created 3 risk models that accurately estimate risk for severe pneumonia in children. Their use holds the potential to improve care and outcomes.

Efficacy of vitamin D in children with pneumonia: a randomized control trial study

Background and Objectives: Pneumonia is the inflammation of parenchyma of lungs. It strictly represents any inflammatory condition that involves the lungs along with the visceral pleura, airways, alveoli, connective tissues and vascular structures. The objective of the study was to see the efficacy of vitamin D in children with pneumonia.Material and Methods: A randomized control study was conducted in Department of Pediatric Medicine, Mayo Hospital, Lahore, Pakistan. One hundred patients with pneumonia received vitamin D along with appropriate antibiotics and one hundred were treated with antibiotics but without vitamin D. The patients were discharged after the fast breathing and chest in drawing settled. The duration of hospital stay was noted. They were followed up for next 90 days after discharge from hospital and any new episode of pneumonia was noted and recorded.Results: The mean number of days to recovery were similar between the group receiving vitamin D (5.7 ± 2.7 days) and the group not receiving vitamin D (6.1 ± 2.8days), (p=0.28). While comparing repeat episode of pneumonia within next three months, the repeat episode of pneumonia was significantly lower in the intervention group (2%) than the group without supplementation (9%; p = 0.002) within 30 days of supplementation of vitamin D.Conclusion: Vitamin D supplementation in a single dose to the children diagnosed as pneumonia significantly reduces the occurrence of new episodes of pneumonia within one month of discharge.Janaki Medical College Journal of Medical Sciences (2015) Vol. 3 (1):5-13

WU and KI polyomavirus infections in Filipino children with lower respiratory tract disease

BackgroundWU and KI are human polyomaviruses initially detected in the respiratory tract, whose clinical significance remains uncertain. ObjectivesTo determine the epidemiology, viral load and clinical characteristics of WU and KI polyomaviruses. Study designWe tested respiratory specimens collected during a randomized, placebo-controlled pneumococcal conjugate vaccine trial and related epidemiological study in the Philippines. We analyzed 1077 nasal washes from patients aged 6 weeks to 5 years who developed lower respiratory tract illness using quantitative real-time PCR for WU and KI. We collected data regarding presenting symptoms, signs, radiographic findings, laboratory data and coinfection. ResultsThe prevalence and co-infection rates for WU were 5.3% and 74% respectively and 4.2% and 84% respectively for KI. Higher KI viral loads were observed in patients with severe or very severe pneumonia, those presenting with chest indrawing, hypoxia without wheeze, convulsions, and with KI monoinfection compared with co-infection. There was no significant association between viral load and clinical presentation for WU. ConclusionsThese findings suggest a potential pathogenic role for KI, and that there is an association between KI viral load and illness severity.

The power of data mining in diagnosis of childhood pneumonia.

Childhood pneumonia is the leading cause of death of children under the age of 5 years globally. Diagnostic information on the presence of infection, severity and aetiology (bacterial versus viral) is crucial for appropriate treatment. However, the derivation of such information requires advanced equipment (such as X-rays) and clinical expertise to correctly assess observational clinical signs (such as chest indrawing); both of these are often unavailable in resource-constrained settings. In this study, these challenges were addressed through the development of a suite of data mining tools, facilitating automated diagnosis through quantifiable features. Findings were validated on a large dataset comprising 780 children diagnosed with pneumonia and 801 age-matched healthy controls. Pneumonia was identified via four quantifiable vital signs (98.2% sensitivity and 97.6% specificity). Moreover, it was shown that severity can be determined through a combination of three vital signs and two lung sounds (72.4% sensitivity and 82.2% specificity); addition of a conventional biomarker (C-reactive protein) further improved severity predictions (89.1% sensitivity and 81.3% specificity). Finally, we demonstrated that aetiology can be determined using three vital signs and a newly proposed biomarker (lipocalin-2) (81.8% sensitivity and 90.6% specificity). These results suggest that a suite of carefully designed machine learning tools can be used to support multi-faceted diagnosis of childhood pneumonia in resource-constrained settings, compensating for the shortage of expensive equipment and highly trained clinicians.

Oral Antibiotics for Community acquired Pneumonia with Chest indrawing in Children Aged Below Five Years: A Systematic Review.

To determine the efficacy of oral antibiotics in under-five children with pneumonia and chest indrawing. We included controlled clinical trials (randomized or quasi randomized) that compared the efficacy of oral antibiotics versus parenteral antibiotics for treatment of community acquired pneumonia with chest indrawing (severe pneumonia as defined by the World Health Organizations guidelines) in children below 60 months of age. Data were extracted and managed using RevMan software. Main outcome variables were: treatment failure rate, relapse rate, death rate, need for hospitalization, and severe adverse effects. We identified four randomized controlled trials involving 4400 children who were diagnosed to have severe pneumonia but were feeding well and not hypoxic. Baseline characteristics of children in the two treatment arms (oral and parenteral antibiotics) were similar. In two studies, oral antibiotics were administered on an ambulatory basis, while in two, oral antibiotics were used in hospitalized children. Failure rate in children receiving oral antibiotics was 13% (288/2208) while that in children receiving parenteral antibiotics was 13.8% (302/2183) (OR 0.93; 95% CI 0.78, 1.11). Failure rates were not affected by the type of oral antibiotic, or presence of wheeze. Relapse rates, hospitalization or serious adverse events were similar in the two groups. Children with tachypnea with chest indrawing without signs and symptoms of very severe pneumonia may be treated with oral antibiotics.

The current status of community-acquired pneumonia management and prevention in children under 5 years of age in India: a review.

India has the highest number of global deaths of children under 5 years of age. In the year 2015, it was reported that there were 5.9 million deaths of children under 5 years of age globally, of which 1.2 million (20%) occurred in India alone. Currently, India has an under 5 mortality rate of 48 per 1000 live births. Community-acquired pneumonia contributes to about one sixth of this mortality. Fast breathing is the key symptom of community-acquired pneumonia. The World Health Organization recently categorized community-acquired pneumonia in children under 5 years of age into two, pneumonia, and severe pneumonia. Fast breathing with or without chest in-drawing is categorized as pneumonia and fast breathing with any of danger signs as severe pneumonia. Because effective vaccines against two of the common organisms causing community-acquired pneumonia, namely Streptococcus pneumoniae and Haemophilus influenzae type b, are available, there should be urgent and phased introduction into the Indian Universal Immunization Programme. Several preventable risk factors of community-acquired pneumonia such as lack of exclusive breast feeding for first 6 months of life, inappropriate complimentary feeding, iron deficiency anemia, malnutrition, and indoor air pollution should be adequately addressed. The community should be aware about the signs and symptoms of community-acquired pneumonia and its danger signs so that delay in qualified care seeking can be avoided. To achieve the sustainable development goal of ⩽25 under five deaths per 1000 live births by 2030, a multipronged approach is the need of the hour.

Enhancing survival of Young Infants to improve Infant Mortality Rate

Background: About 40% of the estimated 10.8 million annual child deaths worldwide occur in first two months of life. Besides mortality infants experience at least five to six episodes of illnesses per year. Despite having the problem well defined there is no consistent evaluations and management approach to infants aged less than three months. Objective: To quantify the nature and burden of illnesses in the first months of life. Methods: This Prospective study was conducted among all consecutive subjects between 8 days to 90 days of age admitted during this period were subjects of this study. They underwent through a standardized set of enquiry clinical examination and investigations. A precoded standardized assessment form was used for data recording. The study subjects were diagnosed and managed according to the protocol of treating unit under the supervision of the senior faculty. Results: The most common clinical signs was chest indrawing- 98 (64.9%) followed by tachycardia- 65 (44.4%). Following factors may have a higher risk of death: wasting rapid breathing and respiratory distress slow / irregular respiration diarrhea dehydration low body temperature with or without impaired perfusion on admission and cyanosis. Conclusion: Presence of risk factors identified in this study should warrant immediate and appropriate measures.

Malnutrition and anaemia associated with hypoxia among hospitalized children with community-acquired pneumonia in North India

ObjectivesTo assess the prevalence and explore the risk factors for hypoxia (SpO2 levels <92%) in ambient air in children hospitalized with community-acquired pneumonia (CAP). MethodsThis was an observational study, conducted in a tertiary care teaching hospital in north India. Included were children aged 1 month to 5 years having pneumonia with lower chest indrawing (LCI) or severe pneumonia. Excluded were those on oxygen supplementation at time of hospitalization, patients in shock, those with cyanotic congenital heart disease and where parental consent was not obtained. World Health Organization criteria were used for assessing the severity of CAP. Anaemia and moderate malnutrition were defined as haemoglobin <10g/dl and weight/height <−2 SD, respectively. Peripheral oxygen saturation was measured using a single, portable, battery-powered pulse oximeter at the time of admission and a cut-off of <92% was used to define hypoxia. Haemoglobin was measured by cyanmethemoglobin method. ResultsFrom July 2013 to June 2014, 165 patients with CAP were admitted, of which 135 patients were eligible for inclusion, and of them, 74.8% (n=101) had pneumonia with LCI and 25.2% (n=34) had severe pneumonia. Hypoxia was found in 40% (n=54/135) of the patients, and of them, 37% (n=20/54) had pneumonia with LCI and 63% (n=34/54) had severe pneumonia. Hypoxia was associated with severity of pneumonia (p value <0.001). In the unconditional logistic model, adjusted risk of hypoxia with malnutrition was 12.1 ((95% CI) 5.0–29.4, p value <0.001) and with anaemia was 4.5 ((95% CI) 1.8–11.2, p value 0.001). ConclusionSince a substantial proportion of CAP had hypoxia at hospitalization, prompt detection at admission is essential especially in children with anaemia and malnutrition. Moreover, primary prevention of malnutrition and anaemia in children less than 5 years would contribute significantly in reducing prevalence of hypoxia and thus CAP-related mortality.

Predictors of Hypoxemia in children (2-60 months) with lower respiratory tract infection

Introduction: Acute lower respiratory tract infection specifically pneumonia, account for considerable number of deaths in under 5 children in our country. Hypoxemia is a dangerous sign which needs to be promptly treated. We have taken up this study in order to point out clinical predictors of hypoxemia so that they can be used at peripheral levels where pulse oxymetry the gold standard for measurement of percent oxygen saturation is unavailable. Materials and Methods: The study was conducted in the pediatric intensive care unit of a medical college over a period of one year. This is a prospective cross sectional study. Children in the age group of 2-60 months were included in the study as per the inclusion criteria. Oxygen saturation of <95% was taken as cut off for hypoxemia. Results: 150 children were studied out of which 35.3% had hypoxemia. Breathlessness, fever, irritability, inability to drink/breast feed, unusual sleepiness, convulsions were the presenting symptoms, out of these fever was present in 84% of children. The most frequent clinical sign was tachypnea (92%), followed by nasal flaring, chest indrawing and crepitations. There were 6 deaths, which were in the hypoxemic group, and no deaths were in the non-hypoxemic group. Conclusion: No single sign is a good predictor of hypoxemia but a combination of signs when used can act as a surrogate for pulse oxymeter. These signs with high positive predictive value can be easily taught to primary health care workers in the peripheral health centers where pulse oxymeters are not available.

Development and Internal Validation of a Predictive Model Including Pulse Oximetry for Hospitalization of Under-Five Children in Bangladesh.

BackgroundThe reduction in the deaths of millions of children who die from infectious diseases requires early initiation of treatment and improved access to care available in health facilities. A major challenge is the lack of objective evidence to guide front line health workers in the community to recognize critical illness in children earlier in their course.MethodsWe undertook a prospective observational study of children less than 5 years of age presenting at the outpatient or emergency department of a rural tertiary care hospital between October 2012 and April 2013. Study physicians collected clinical signs and symptoms from the facility records, and with a mobile application performed recordings of oxygen saturation, heart rate and respiratory rate. Facility physicians decided the need for hospital admission without knowledge of the oxygen saturation. Multiple logistic predictive models were tested.FindingsTwenty-five percent of the 3374 assessed children, with a median (interquartile range) age of 1.02 (0.42–2.24), were admitted to hospital. We were unable to contact 20% of subjects after their visit. A logistic regression model using continuous oxygen saturation, respiratory rate, temperature and age combined with dichotomous signs of chest indrawing, lethargy, irritability and symptoms of cough, diarrhea and fast or difficult breathing predicted admission to hospital with an area under the receiver operating characteristic curve of 0.89 (95% confidence interval -CI: 0.87 to 0.90). At a risk threshold of 25% for admission, the sensitivity was 77% (95% CI: 74% to 80%), specificity was 87% (95% CI: 86% to 88%), positive predictive value was 70% (95% CI: 67% to 73%) and negative predictive value was 91% (95% CI: 90% to 92%).ConclusionA model using oxygen saturation, respiratory rate and temperature in combination with readily obtained clinical signs and symptoms predicted the need for hospitalization of critically ill children. External validation of this model in a community setting will be required before adoption into clinical practice.

A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 - 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study.

BackgroundPneumonia is the leading cause of child mortality under five years of age worldwide. For pneumonia with chest indrawing in children aged 3–59 months, injectable penicillin and hospitalization was the recommended treatment. This increased the health care cost and exposure to nosocomial infections. We compared the clinical and cost outcomes of a seven day treatment with oral amoxicillin with the first 48 h of treatment given in the hospital (hospital group) or at home (home group).MethodsWe conducted an open-label, multi-center, two-arm randomized clinical trial at six tertiary hospitals in India. Children aged 3 to 59 months with chest indrawing pneumonia were randomized to home or hospital group. Clinical outcomes, treatment adherence, and patient safety were monitored through home visits on day 3, 5, 8, and 14 with an additional visit for the home group at 24 h. Clinical outcomes included treatment failure rates up to 7 days (primary outcome) and between 8–14 days (secondary outcome) using the intention to treat and per protocol analyses. Cost outcomes included direct medical, direct non-medical and indirect costs for a random 17 % subsample using the micro-costing technique.Results1118 children were enrolled and randomized to home (n = 554) or hospital group (n = 564). Both groups had similar baseline characteristics. Overall treatment failure rate was 11.5 % (per protocol analysis). The hospital group was significantly more likely to fail treatment than the home group in the intention to treat analysis. Predictors with increased risk of treatment failure at any time were age 3–11 months, receiving antibiotics within 48 h prior to enrolment and use of high polluting fuel. Death rates at 7 or 14 days did not differ significantly. (Difference −0.0 %; 95 % CI −0.5 to 0.5). The median total treatment cost was Rs. 399 for the home group versus Rs. 602 for the hospital group (p < 0.001), for the same effect of 5 % failure rate at the end of 7 days of treatment in the random subsample.ConclusionsHome based oral amoxicillin treatment was equivalent to hospital treatment for first 48 h in selected children of chest indrawing pneumonia and was cheaper. Consistent with the recent WHO simplified guidelines, management with home based oral amoxicillin for select children with only fast breathing and chest-indrawing can be a cost effective intervention.Trial RegistrationClinicalTrials.gov NCT01386840, registered 25th June 2011 and the Indian Council of Medical Research REFCTRI/2010/000629.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0510-9) contains supplementary material, which is available to authorized users.

Differences upon admission and in hospital course of children hospitalized with community-acquired pneumonia with or without radiologically-confirmed pneumonia: a retrospective cohort study.

BackgroundThe use of chest radiograph (CXR) for the diagnosis of childhood community-acquired pneumonia (CAP) is controversial. We assessed if children with CAP diagnosed on clinical grounds, with or without radiologically-confirmed pneumonia on admission, evolved differently.MethodsChildren aged ≥ 2 months, hospitalized with CAP diagnosed on clinical grounds, treated with 200,000 IU/Kg/day of aqueous penicillin G for ≥ 48 h and with CXR taken upon admission, without pleural effusion, were included in this retrospective cohort. One researcher, blinded to the radiological diagnosis, collected data on demographics, clinical history and physical examination on admission, daily hospital course during the first 2 days of treatment, and outcome, all from medical charts. Radiological confirmation of pneumonia was based on presence of pulmonary infiltrate detected by a paediatric radiologist who was also blinded to clinical data. Variables were initially compared by bivariate analysis. Multi-variable logistic regression analysis assessed independent association between radiologically-confirmed pneumonia and factors which significantly differed during hospital course in the bivariate analysis. The multi-variable analysis was performed in a model adjusted for age and for the same factor present upon admission.Results109 (38.5 %) children had radiologically-confirmed pneumonia, 143 (50.5 %) had normal CXR and 31 (11.0 %) had atelectasis or peribronchial thickening. Children without radiologically-confirmed pneumonia were younger than those with radiologically-confirmed pneumonia (median [IQR]: 14 [7–28 months versus 21 [12–44] months; P = 0.001). None died. The subgroup with radiologically-confirmed pneumonia presented fever on D1 (33.7 vs. 19.1; P = 0.015) and on D2 (31.6 % vs. 16.2 %; P = 0.004) more frequently. The subgroup without radiologically-confirmed pneumonia had chest indrawing on D1 (22.4 % vs. 11.9 %; P = 0.027) more often detected. By multi-variable analysis, Fever on D2 (OR [95 % CI]: 2.16 [1.15-4.06]) was directly and independently associated with radiologically-confirmed pneumonia upon admission.ConclusionThe compared subgroups evolved differently.

Adherence to case management guidelines of Integrated Management of Childhood Illness (IMCI) by healthcare workers in Tshwane, South Africa

Background. Integrated Management of Childhood Illness (IMCI) is an essential strategy known to deliver childhood interventions that reduce the under-five mortality rate. Objective. To evaluate the adherence to the IMCI case management guidelines by primary healthcare workers in the Tshwane area, South Africa. Methods. The study was conducted between July and December 2012 on children referred from clinics to Kalafong Hospital. Data on IMCI clinical symptoms and signs, classification and treatment given at the clinics before referral to the hospital were collected from patients’ referral letters. An interview with the caregiver on counselling received at the clinic was done using an adapted World Health Organization health facility survey tool. Results. Eighty children between 2 and 60 months referred from 12 local clinics were included in the study. IMCI classification was done in just over half (52.9%) of 34 children with cough and 73% of 15 children with diarrhoea. Only 18% of children with chest indrawing and fast breathing were classified correctly. Prereferral treatment for all children with severe dehydration had been given correctly but not so for children with severe pneumonia and severe malnutrition. None of the children with severe disease had been checked for glucose levels before referral. Conclusions. The IMCI guidelines had not been adhered to in all children referred to the hospital. Children, particularly those with severe disease, had been incorrectly classified, leading to inadequate prereferral treatment. Healthcare workers had not given the expected treatment at the clinic before referral.

Oral Zinc as Adjuvant Therapy for Pediatric Recurrent Pneumonia: A Prospective Study in a Tertiary Care Hospital

Zinc is an essential element required for the cell metabolism, including immunity. Therefore Zinc deficiency leads to susceptibility to infections and may affect pulmonary epithelial cell integrity. Many investigators have used zinc supplementation to see it’s effect on various diseases mainly diarrheal diseases and severe pneumonia. This study aims to evaluate the effect of oral Zinc supplementation in treatment and prevention of recurrent pneumonia. 506 Children aged 2 months to 60 months admitted during September 2011 to August 2014 for recurrent pneumonia with no other underlying illness in the Pediatric department of Manipal Teaching Hospital, Pokhara, Nepal were observed. Along with standard antibiotic treatment one group [Group I] received zinc (10 mg for < 6 months and 20 mg for ≥ 6 months for 10 days) and another group [Group II] did not receive Zinc. The primary outcome like resolution of tachypnea, chest in drawing, hypoxia, starting of oral feeds and hospital stay was noted. All cases were followed up every three monthly for one year to see the recurrence of pneumonia. Data was analyzed using SPSS version 16 and p < 0.01 was considered statistically significant. 20.24% of recurrent pneumonia meeting the inclusion criteria was evaluated. Maximum children (65.4%) were of age 2-12 months. Primary as well as secondary outcome was statistically significant (p<0.001) in Group I. The mean ± SD for primary outcome in Group I vs. Group II were –tachypnea (2.96±1.12 vs. 4.67 ± 1.61 days), chest in drawings (1.63 ±0.95 vs. 3.35 ±1.55 days), hypoxia (24.61 ±1.77 vs. 41.67 ± 2.11 hours), starting of oral feed (1.22 ±0.95 vs. 2.55 ± 1.23 days) and hospital stay (4.82 ±1.22 vs. 6.45 ± 1.99 days). In Group I 20/253 (7.9%) children lost follow up and 2/253(0.79%) patient died and in group II 1 (0.39%) died and 30 (11.85%) lost follow up. Recurrence of pneumonia was also significantly less (p<0.001) in zinc recipients. Determinants in two groups by logistic regression showed earlier resolution in zinc recipients with OR at 99% CI 9.654 (5.605, 16.625) for tachypnea, 14.506 (8.064, 26.095) for chest in drawings, 5.860 (3.415, 10.057) for hypoxia, 13.725 (7.270, 25.912) for starting oral feed and 0.075 (0.040, 0.140) for hospital stay. The recurrence of pneumonia was also less in group I with OR 3.348 at 99% CI (2.009, 5.581). Zinc as an adjuvant therapy is effective in treatment and prevention of recurrent pneumonia in children.

Risk Factors Analysis in Asphyxiated Newborn and Their Neurological Outcome in Relation to Hypoxic-Ischaemic Encephalopathy

Background: Perinatal mortality rate in the developing world is still significantly higher than what obtained in the individualized nation1. Perinatal asphyxia has been established as one of the major causes of these deaths. Perinatal asphyxia is a serious clinical problem world wide. There are various reasons of failure to initiate and sustain breathing immediately after birth. Neurological complication like hypoxic ischaemic encephalopathy (HIE) following damage to the brain is very frequent and commonly seen in asphyxiated newborn .Objective: To find out the risk factors and the hospital outcome with special emphasis on HIE following perinatal asphyxia.Methods: It was a retrospective study on 92 (ninety two) consecutive cases of perinatal asphyxia admitted in the neonatal care unit of Sir Salimullah Medical College and Mitford Hospital during the period of January and February 2011.Results: The results revealed that during the study period the number of perinatal asphyxia in admitted in neonatal care unit was 92 out of 193 i.e. 47.6%. Out of 92 asphyxiated newborn 86% were admitted in first 24 hours of life. Among them 71% were inborn and of male sex. Most of them (69%) were of normal birth weight. Regarding gestational age 56% were term. Fifty one percent were delivered per vaginally. Majority of mothers (79%) received antenatal care. Intrapartum risk factors included premature rupture of membrane (PROM) 19%, prolonged labour 15%, pregnancy induced hypertension 13%, antepartum haemorrhage 13%, preeclampsia and eclampsia 10%, obstructed labour 10%, malpresentation 8%, multiple gestation 8%. 60% mothers had multiparity. Presenting complaints were respiratory distress characterized by tachypnea /chest indrawing (30%), grunting (25%), convulsion (21%), irritability or excessive crying (9%), poor feeding or sucking (8.6%). About neurological complications 45% developed hypoxic ischaemic encephalopathy. Out of 42 HIE cases 60% had grade II encephalopathy. Grade I HIE was found in 26% of cases and 14% cases had grade III or severe encephalopathy. About hospital outcome 58% had hospital stay for minimum 5 days and 63% were discharged after improvement Thirteen percent were discharged on risk bond. 22 cases died during hospitalizationConclusion &amp; Recommendation: The rate of hospital admission of Perinatal asphyxia as well as Neurological complication like hypoxic ischemic encephalopathy (HIE) was very high though majority of mother received antenatal care and affected newborns were inborn. So proper attention and timely intervention as well as resuscitation of newborn delivered in the hospital is essential to prevent the unwanted neurological complication of Perinatal asphyxia like HIE as well as other morbidity and fatality.J. Paediatr. Surg. Bangladesh 4(2): 54-57, 2013 (July)