Diagnosis Of Pneumonia In Children Research Articles

ЭТИОЛОГИЧЕСКАЯ СТРУКТУРА ОСТРОЙ ВНЕБОЛЬНИЧНОЙ ПНЕВМОНИИ У ДЕТЕЙ

Background. Difficulties in the etiological diagnosis of pneumonia in children are due to its polyetiology. Pneumonia can be caused by both typical bacterial agents and atypical pathogens. The condition of frequently ill children is characterized by a combination of several pathogens, in particular, a viral-bacterial association. The frequent use of antibacterial therapy in a group of frequently ill children should be taken into account when choosing initial therapy in a hospital. Objective. To establish the etiological structure of acute community-acquired pneumonia in frequently ill children. Material and methods. 180 children (1st group 50/180 - children belonged to the group of frequently ill children, 2nd group 130/180 - children did not belong to the group of frequently ill children) with a diagnosis of "acute communityacquired pneumonia" were examined in accordance with the protocol with assessment of the etiological structure. Results. The total number of frequently ill children was 27.8% (50/180). The somatic type of “truly” frequently ill children occurs 2.3 times more often (RR=2.33; 95% CI 1.4720-3.6986; p=0.0003) than the otorhinolaryngological type. The infection index in patients from the group of frequently ill children is 3.0 times higher (p=0.0002), the resistance index is 3.5 times higher (p=0.0012), compared with the group of infrequently ill children. In the group of frequently ill children, there was a higher frequency of acute illnesses during the year and the development of complications from acute respiratory infections. Conclusion. The causative agent of pneumonia was diagnosed in every third patient, in the remaining patients the causative agent was undifferentiated, while atypical pathogens (Chlamydophila рneumoniae and Mycoplasma рneumoniae) were diagnosed 4.7 times more often (RR=4.773; 95% CI 2.9620-7.6901; p=0.0024) than grampositive, gram-negative flora.

Procalcitonin as Point-of-Care Testing Modality for the Diagnosis of Pneumonia in Children With Influenza-like Illness

Procalcitonin as Point-of-Care Testing Modality for the Diagnosis of Pneumonia in Children With Influenza-like Illness

Diagnostic Accuracy of Lung Ultrasound in Diagnosis of Pneumonia in Children using Chest X-RAY as Gold Standard

Objective: To determine the diagnostic accuracy of lung ultrasound (LUS) in the diagnosis of pneumonia in children using chest x-ray as the gold standard. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Radiology, Combined Military Hospital, Sialkot Pakistan, from Feb to Aug 2021 Methodology: All patients underwent clinical examination, chest radiograph (anterior-posterior view), lung ultrasound and blood sample analysis in the first 24 hours after admission. A pre-specified hospital radiologist carried out a lung ultrasound. The examination was performed with the patient sitting upright or supine. The presence of pneumonia on x-ray and USG were recorded. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of lung ultrasound in the diagnosis of pneumonia by taking chest x-ray as the gold standard was calculated in all the study participants. Results: In this study, 262 patients with clinical features of pneumonia were enrolled. The mean age of the study participants was 3.27±2.344 years. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), accuracy and frequency of lung ultrasonography (US) vs chest radiography (CR) in diagnosing pneumonia was 95.28%, 87.5%, 99.59%, 36.84%, 95.04% and 96.95% respectively. Conclusion: Lung ultrasound emerged as a sensitive diagnostic tool to diagnose pneumonia in children. Sensitivity, specificity, positive predictive value, and negative predictive value all favoured the use of this modality to diagnose pneumonia in paediatric patients.

A comprehensive segmentation of chest X-ray improves deep learning-based WHO radiologically confirmed pneumonia diagnosis in children.

To investigate a comprehensive segmentation of chest X-ray (CXR) in promoting deep learning-based World Health Organization's (WHO) radiologically confirmed pneumonia diagnosis in children. A total of 4400 participants between January 2016 and June 2021were identified for a cross-sectional study and divided into primary endpoint pneumonia (PEP), other infiltrates, and normal groups according to WHO's diagnostic criteria. The CXR was divided into six segments of left lung, right lung, mediastinum, diaphragm, ext-left lung, and ext-right lung by adopting the RA-UNet. To demonstrate the benefits of lung field segmentation in pneumonia diagnosis, the segmented images and images that were not segmented, which constituted seven segmentation combinations, were fed into the CBAM-ResNet under a three-category classification comparison. The interpretability of the CBAM-ResNet for pneumonia diagnosis was also performed by adopting a Grad-CAM module. The RA-UNet achieved a high spatial overlap between manual and automatic segmentation (averaged DSC = 0.9639). The CBAM-ResNet when fed with the six segments achieved superior three-category diagnosis performance (accuracy = 0.8243) over other segmentation combinations and deep learning models under comparison, which was increased by around 6% in accuracy, precision, specificity, sensitivity, F1-score, and around 3% in AUC. The Grad-CAM could capture the pneumonia lesions more accurately, generating a more interpretable visualization and enhancing the superiority and reliability of our study in assisting pediatric pneumonia diagnosis. The comprehensive segmentation of CXR could improve deep learning-based pneumonia diagnosis in childhood with a more reasonable WHO's radiological standardized pneumonia classification instead of conventional dichotomous bacterial pneumonia and viral pneumonia. The comprehensive segmentation of chest X-ray improves deep learning-based WHO confirmed pneumonia diagnosis in children, laying a strong foundation for the potential inclusion of computer-aided pediatric CXR readings in precise classification of pneumonia and PCV vaccine trials efficacy in children. • The chest X-ray was comprehensively segmented into six anatomical structures of left lung, right lung, mediastinum, diaphragm, ext-left lung, and ext-right lung. • The comprehensive segmentation improved the three-category classification of primary endpoint pneumonia, other infiltrates, and normal with an increase by around 6% in accuracy, precision, specificity, sensitivity, F1-score, and around 3% in AUC. • The comprehensive segmentation gave rise to a more accurate and interpretable visualization results in capturing the pneumonia lesions.

Health System Considerations for Community-Based Implementation of Automated Respiratory Counters to Identify Childhood Pneumonia in 5 Regions of Ethiopia: A Qualitative Study.

In Ethiopia, childhood pneumonia is diagnosed in primary healthcare settings by measuring respiratory rate (RR) along with the presence of cough, chest indrawing, difficulty breathing, and fast breathing. Our aim was to identify health system-level lessons from implementing two automated RR counters, Children's Automated Respiration Monitor (ChARM) by Phillips® and Rad-G by Masimo®, to provide considerations for integrating such devices into child health programmes and health systems. This study was part of an initiative called the Acute Respiratory Infection Diagnostic Aids (ARIDA). Key informant interviews (KIIs) were conducted with 57 participants (health workers in communities and facilities, trainers of health workers, district management, and key decision-makers) in five regions of Ethiopia. Data were analyzed in ATLAS.ti using thematic content analysis and themes were categorized using the Tanahashi bottleneck analysis. All participants recommended scaling up the ARIDA initiative nationally as part of Integrated Management of Newborn and Childhood Illness (IMNCI) in primary healthcare. Health workers perceived the devices as: time saving, acceptable by parents and children, and facilitating diagnosis and referrals. Health workers perceived an increased demand for services and reduced numbers of sick children not seeking care. Participants recommended increasing the number of devices distributed and health workers trained. Strengthening drug supply chains, improving oxygen gas availability, and strengthening referral networks would maximize perceived benefits. While training improved knowledge, more supportive supervision, integration with current guidelines and more guidance related to community engagement was recommended. Automatic RR counters for the decentralized diagnosis of childhood pneumonia could have positive impact on improving the quality of diagnosis and management of pneumonia in children. However, the study has shown that a health system approach is required to ensure all steps along the pneumonia pathway are adequate, including drug and oxygen supply, community engagement, health worker training and support, and referral pathways.

Feasibility and acceptability of the paediatric pulse oximeter in integrated management of neonatal and childhood illnesses (IMNCI) services by public health facilities: A qualitative study in rural Western India.

Pneumonia contributes to about 15% of child deaths globally, with 20% of the overall deaths occurring in India. Although WHO recommends the use of pulse oximeters (PO) in first-level facilities for early detection of child pneumonia in low- and middle-income countries (LMICs), this has not yet been implemented in India. We aimed to assess the feasibility and acceptability of introducing PO in integrated management of neonatal and childhood illnesses (IMNCI) services at primary health centres (PHC) in the rural Pune district. We identified medical officers (MO) and auxiliary nurse midwives (ANM) from six PHCs as study participants due to their involvement in the treatment of children. We developed in-depth interview (IDI) guides for both groups to explore their IMNCI knowledge and attitude towards the program through a qualitative study. We conducted interviews with MOs (n = 6) and ANMs (n = 6) from each PHC. The PO module was added to explore perceptions about its usefulness in diagnosing pneumonia. After baseline assessment, we conducted training sessions on adapted IMNCI services (including PO use) for MOs and ANMs. PO devices were provided at the study PHCs. At baseline, no PO devices were being used at study PHCs; PHC staff demonstrated satisfactory knowledge about paediatric pneumonia management and demanded refresher IMNCI training. They also felt the need to reiterate the PO use for early diagnosis of pneumonia in children and highlighted the challenges encountered in managing pneumonia at PHCs, such as health system-related challenges and parents' attitudes towards care seeking. There was positive acceptance of training and PO started to be used immediately in PHCs. There was increased confidence in using PO at endline. PO use in examining symptomatic children increased from 26 to 85%. Paediatric PO implementation could be integrated successfully at PHC levels; we found pre-implementation training and provision of PO to PHCs to be helpful in achieving this goal. This intervention demonstrated that an algorithm to diagnose pneumonia in children that included PO could improve case management.

Sono-Elastography: An Ultrasound Quantitative Non-Invasive Measurement to Guide Bacterial Pneumonia Diagnosis in Children.

Lung ultrasound (LUS) is, at present, a standard technique for the diagnosis of acute lower respiratory tract infections (ALRTI) and other lung pathologies. Its protocolised use has replaced chest radiography and has led to a drastic reduction in radiation exposure in children. Despite its undeniable usefulness, there are situations in which certain quantitative measurements could provide additional data to differentiate the etiology of some pulmonary processes and thus adapt the treatment. Our research group hypothesises that several lung processes such pneumonia may lead to altered lung tissue stiffness, which could be quantified with new diagnostic tests such as lung sono-elastography (SE). An exhaustive review of the literature has been carried out, concluding that the role of SE for the study of pulmonary processes is currently scarce and poorly studied, particularly in pediatrics. The aim of this review is to provide an overview of the technical aspects of SE and to explore its potential usefulness as a non-invasive diagnostic technique for ALRTI in children by implementing an institutional image acquisition protocol.

End-user acceptability of a prototype digital stethoscope to diagnose childhood pneumonia- a qualitative exploration from Sylhet, Bangladesh

BackgroundConsidering the high frequency of respiratory infections among children in low- and middle-income countries (LMICs), the World Health Organization (WHO) developed a pragmatic guideline for managing pneumonia in low-resource settings. The guideline’s low specificity leads to many false-positive pneumonia cases receiving antibiotic treatment. Integrating diagnostic technology to incorporate lung sounds into WHO guidelines could improve childhood pneumonia diagnosis and management. This qualitative study aimed to explore the acceptability of a prototype digital stethoscope device among potential end-users in Bangladesh.MethodsWe conducted four focus group discussions (FGDs) with beneficiaries and service providers who used a 2018 digital stethoscope prototype. The data collection was conducted in November 2020. The study was carried out at Zakiganj Upazila (sub-district) of Sylhet district of Bangladesh. A total of 34 respondents, including parents of under-5 children, Community Health Care Providers (CHCPs), and community leaders were enrolled. Two researchers (TJ and a research assistant (not a co-author of this manuscript) conducted the FGDs. Verbatim transcripts were prepared, and translations were completed. Coding was executed in Microsoft Excel, and relevant quotes were extracted to ascertain the emerging themes. To ensure validity, two researchers coded the dataset independently and inconsistencies were resolved through discussion.FindingsMothers were more aware of the digital stethoscope than fathers. Except for the female community leaders, male leaders were unaware of the stethoscopes. Most CHCPs had positive perceptions of the digital stethoscope. They appreciated stethoscope training as they learned about new technology and diagnostic approaches. The users mentioned several technical shortcomings of the prototype device. A few stakeholders expressed dissatisfaction with the level of community involvement and information sharing from the study. The use of the device plummeted during the COVID-19 pandemic for fear of infection, to counteract which the CHCPs cleaned the device with chlorhexidine after every application as a precaution.ConclusionOverall, device use was supported by stakeholders despite perceptions that the prototype had some technological limitations, community engagement was suboptimal, and the COVID-19 pandemic caused disruptions. Stronger community engagement, addressing technological issues, and further research on its health systems application would improve the acceptability and effective use of the digital stethoscope.

The ability of non-physician health workers to identify chest indrawing to detect pneumonia in children below five years of age in low- and middle-income countries: A systematic review and meta-analysis.

Non-physician health workers play a vital role in diagnosing and treating pneumonia in children in low- and middle-income countries (LMICs). Chest indrawing is a key indicator for pneumonia diagnosis, signifying the severity of the disease. We conducted this systematic review to summarize the evidence on non-physician health workers' ability to identify chest indrawing to detect pneumonia in children below five years of age in LMICs. We comprehensively searched four electronic databases, including MEDLINE, Embase, Web of Science, and Scopus, and reference lists from the identified studies, from January 1, 1990, to January 20, 2022, with no language restrictions. Studies evaluating the performance of non-physician health workers in identifying chest indrawing compared to a reference standard were included. We used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool to assess the methodological quality of the selected studies and conducted a meta-analysis following a bivariate random effects model to estimate the pooled sensitivity and specificity. We identified nine studies covering 4468 children that reported the accuracy of a non-physician health worker in identifying chest indrawing. Most studies were conducted in the 1990s, based at health facility settings, with children aged 2-59 months, and with pediatricians/physicians as the reference standard. Using the QUADAS-2, we evaluated most studies as having a low risk of bias and a low concern regarding applicability in all domains. The median sensitivity, specificity, positive predictive value, and negative predictive value were 44%, 97%, 55%, and 95%, respectively. We selected five studies for the meta-analysis. The pooled sensitivity was 46% (95% confidence interval (CI) = 37-56), and the pooled specificity was 95% (95% CI = 91-97). We found the ability of non-physician health workers in LMICs in identifying chest indrawing pneumonia is relatively poor. Appropriate measures, such as targeted identification and training, supportive supervision, regular performance assessment, and feedback for those who have a poor ability to recognize chest indrawing, should be taken to improve the diagnosis of pneumonia in children. New studies are needed to assess the new generation of health workers. PROSPERO (CRD42022306954).

Bedside lung ultrasound for the diagnosis of pneumonia in children presenting to an emergency department in a resource-limited setting

BackgroundLung ultrasound (LUS) is an effective tool for diagnosing pneumonia; however, this has not been well studied in resource-limited settings where pneumonia is the leading cause of death in children under 5 years of age.ObjectiveThe objective of this study was to evaluate the diagnostic accuracy of bedside LUS for diagnosis of pneumonia in children presenting to an emergency department (ED) in a resource-limited setting.MethodsThis was a prospective cross-sectional study of children presenting to an ED with respiratory complaints conducted in Nepal. We included all children under 5 years of age with cough, fever, or difficulty breathing who received a chest radiograph. A bedside LUS was performed and interpreted by the treating clinician on all children prior to chest radiograph. The criterion standard was radiographic pneumonia, diagnosed by a panel of radiologists using the Chest Radiography in Epidemiological Studies methodology. The primary outcome was sensitivity and specificity of LUS for the diagnosis of pneumonia. All LUS images were later reviewed and interpreted by a blinded expert sonographer.ResultsThree hundred and sixty-six children were enrolled in the study. The median age was 16.5 months (IQR 22) and 57.3% were male. Eighty-four patients (23%) were diagnosed with pneumonia by chest X-ray. Sensitivity, specificity, positive and negative likelihood ratios for clinician’s LUS interpretation was 89.3% (95% CI 81–95), 86.1% (95%CI 82–90), 6.4, and 0.12 respectively. LUS demonstrated good diagnostic accuracy for pneumonia with an area under the curve of 0.88 (95% CI 0.83–0.92). Interrater agreement between clinician and expert ultrasound interpretation was excellent (k = 0.85).ConclusionBedside LUS when used by ED clinicians had good accuracy for diagnosis of pneumonia in children in a resource-limited setting.

Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Community Acquired Pneumonia in Children: A Cross-sectional Study

Introduction: Pneumonia is one of the most common causes of childhood morbidity and mortality, which warrants a proper diagnosis and adequate treatment. Early diagnosis of Community Acquired Pneumonia (CAP) is essential to reduce the total burden of this disease. Aim: To evaluate the diagnostic accuracy of Lung Ultrasound (LUS) in CAP in children as compared to Chest Radiograph (CXR). Materials and Methods: This was a cross-sectional study involving 91 subjects with clinically suspected pneumonia, who underwent US examination in the Department of Radiodiagnosis, Government Medical College, Thrissur, Kerala, India from December 2018 to December 2019. LUS was done to obtain information regarding different patterns of presentation of pneumonia. Although Computed Tomography (CT) is considered the gold standard imaging for pneumonia, it is used only for complicated pneumonia and is not routinely performed in the paediatric age group as radiation exposure will be more than that of the CXR. Hence, a CXR was taken as a reference standard in this study, and findings of LUS were compared. The data was managed using Microsoft Excel 2016 and statistical analysis was done with International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) version 27.0. The sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy were calculated. Results: Overall, LUS had a sensitivity of 95.83%, a specificity of 93.02%, a PPV of 93.88%, a NPV of 95.24%, and an accuracy of 94.5% (p<0.001) as compared to CXR which had a sensitivity of 93.8%, specificity of 95.23%, the PPV of 95.80%, the NPV of 93.0% and accuracy of 95%. Substantial agreement between LUS and a CXR was found, for diagnosing specific patterns of CAP with Cohen’s Kappa value of 0.74. Conclusion: LUS offers an important contribution to the diagnosis of pneumonia in children as compared with a CXR. With its high NPV, it can replace CXR in order to exclude lung consolidation in children, thus reducing radiation exposure in this population.

Lung Ultrasonography in the Diagnosis of Childhood Pneumonia

Lung Ultrasonography in the Diagnosis of Childhood Pneumonia

Strategies for recognizing pneumonia look-alikes.

Community-acquired pneumonia is a common diagnosis in children. Among the many children whose symptoms and/or chest X-ray is consistent with community-acquired pneumonia, it can be difficult to distinguish the rare cases of differential diagnoses that require specific management. The aim of this educational article is to provide clinicians with a series of questions to ask themselves in order to detect a possible differential diagnosis of pneumonia in children. The value of this approach is illustrated by 13 real clinical cases in which a child was misdiagnosed as having lobar pneumonia. What is Known: •When a lobar pneumonia is diagnosed, an appropriate antibiotic treatment leads to the resolution of the clinical signs in most cases. • However, several diseases can be look-alikes for pneumonia and mislead the practitioner. What is New: •This article provides a new approach to identify differential diagnoses of pneumonia in children. •It is illustrated by 13 real-life situations of children misdiagnosed as having pneumonia.

Childhood Pneumonia Diagnostics in Sub-Saharan Africa: A Systematic Review.

The prompt and accurate aetiological diagnosis of childhood pneumonia remains a challenge, especially in sub-Saharan Africa (SSA) because of limited resources for disease management. To review existing diagnostics for childhood pneumonia and potential modalities available to differentiate between bacterial and viral aetiologies in SSA. Online databases were searched for relevant articles published between January 2010 and December 2020 regarding childhood pneumonia diagnosis, conducted in SSA in children less than 18 years of age. The 2020 PRISMA checklist was utilized in appraising the selected studies and the QUADAS-2 tool was employed to assess the risk of bias in each of the studies selected. A total of 1542 study titles and abstracts were screened following which 45 studies (39 on childhood pneumonia diagnostics and 6 on discriminating between bacterial and viral childhood pneumonia) were selected for review. Microbiological investigations (79.7%) constituted the most utilized index tests with blood-related specimen (32.8%) being the most utilized specimen. The most performed index diagnostic modality was polymerase chain reaction (PCR) (53.1%). The commonest reference gold standard technique was based on clinical diagnosis of the disease (46.2%). Only six studies in SSA attempted at using serum biomarkers, either singly or in combination to distinguish between aetiologies with use of combined biomarkers showing promise. Microbiological investigations are the most employed diagnostic methods for childhood pneumonia in SSA. More studies are required to evaluate the potential use of serum biomarkers; either singly or in combination with the goal of discriminating bacterial and viral childhood pneumonia.

Digital auscultation as a diagnostic aid to detect childhood pneumonia: A systematic review

BackgroundFrontline health care workers use World Health Organization Integrated Management of Childhood Illnesses (IMCI) guidelines for child pneumonia care in low-resource settings. IMCI guideline pneumonia diagnostic criterion performs with low specificity, resulting in antibiotic overtreatment. Digital auscultation with automated lung sound analysis may improve the diagnostic performance of IMCI pneumonia guidelines. This systematic review aims to summarize the evidence on detecting adventitious lung sounds by digital auscultation with automated analysis compared to reference physician acoustic analysis for child pneumonia diagnosis.MethodsIn this review, articles were searched from MEDLINE, Embase, CINAHL Plus, Web of Science, Global Health, IEEExplore database, Scopus, and the ClinicalTrial.gov databases from the inception of each database to October 27, 2021, and reference lists of selected studies and relevant review articles were searched manually. Studies reporting diagnostic performance of digital auscultation and/or computerized lung sound analysis compared against physicians’ acoustic analysis for pneumonia diagnosis in children under the age of 5 were eligible for this systematic review. Retrieved citations were screened and eligible studies were included for extraction. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. All these steps were independently performed by two authors and disagreements between the reviewers were resolved through discussion with an arbiter. Narrative data synthesis was performed.ResultsA total of 3801 citations were screened and 46 full-text articles were assessed. 10 studies met the inclusion criteria. Half of the studies used a publicly available respiratory sound database to evaluate their proposed work. Reported methodologies/approaches and performance metrics for classifying adventitious lung sounds varied widely across the included studies. All included studies except one reported overall diagnostic performance of the digital auscultation/computerised sound analysis to distinguish adventitious lung sounds, irrespective of the disease condition or age of the participants. The reported accuracies for classifying adventitious lung sounds in the included studies varied from 66.3% to 100%. However, it remained unclear to what extent these results would be applicable for classifying adventitious lung sounds in children with pneumonia.ConclusionsThis systematic review found very limited evidence on the diagnostic performance of digital auscultation to diagnose pneumonia in children. Well-designed studies and robust reporting are required to evaluate the accuracy of digital auscultation in the paediatric population.

MODERN VIEWS ON THE PREVALENCE OF PNEUMONIA IN CHILDREN AND THE ROLE OF LABORATORY DIAGNOSIS: A REVIEW OF THE LITERATURE

An analysis of domestic and foreign literature on the prevalence, causes and mechanisms of pneumonia in children. This article highlights the prevalence and features of the clinic and diagnosis of pneumonia in children based on a review of the literature. Out-of-hospital pneumonia today remains a pressing medical and social problem, often leading to complications and often causing the death of children, both in Ukraine and around the world, so it needs more in-depth diagnosis. It is known that the severity of this disease depends on age, etiology, comorbidity and timely hospitalization. The incidence and prevalence of respiratory diseases is one of the main indicators of health among children in the world. Therefore, the purpose of this research is to analyze foreign and domestic literature sources on the prevalence and search for the most informative diagnostic criteria for pneumonia in young children. More recent meta-analyzes of etiological data indicate a change in the profile of the pathogen, which increases the recognition that community-acquired pneumonia is caused by sequential or simultaneous interaction of more than one microorganism. Given the epidemiology of community-acquired pneumonia and long-term hospital stays, the study and synthesis of data on the diagnostic criteria for community-acquired pneumonia remains relevant. It is currently not possible to identify a single marker or clinical sign that can be used to distinguish bacterial from viral pneumonia. It is important to evaluate all indicators of objective, instrumental and laboratory examination. Based on literature data, cytokine status indicators can be used to prevent the development of complications from pneumonia, prescribe adequate therapy and determine the duration of treatment. There are many other biomarkers that have been linked to the severity of pneumonia in children. According to statistics, a study of children with COVID-19 showed that the blood of patients, especially those with severe disease, has high levels of proinflammatory cytokines, especially IL-6, which during infection may be a key cytokine that causes serious inflammation and acute damage to many organs and systems. In particular, such a biomarker is IL-6 - the only serum cytokine, the presence of which probably correlates with the severity of pneumonia. The relationship between serum IL-6 and IL-10 levels is an important diagnostic criterion for determining the severity of pneumonia in children on admission, which allows screening for the risk of complications and assessing the possibility of rapid recovery. The use of immune and inflammatory markers in children with pneumonia can potentially lead to the development of innovative methods for predicting complications of community-acquired pneumonia and determining the severity. In addition, it has been shown that serum IL-6 levels are significantly reduced in patients with pneumonia during the recovery period, which allows to evaluate the effectiveness of treatment. Procalcitonin is also an important indicator of the inflammatory process. There are conflicting data on the ability of procalcitonin to distinguish between bacterial and viral infections. Given these data, procalcitonin can be used as a diagnostic criterion for the presence of bacterial infection and the appropriateness of antibiotic therapy. Analysis of available scientific works on prevalence features of the clinic and diagnosis of pneumonia in children, showed that the issue of timely diagnosis and differential diagnosis of pneumonia in children is still relevant and requires further research.

Value Comparison of Iterative Reconstruction Algorithm-Based Chest CT and Ultrasound in the Diagnosis of Community-Acquired Pneumonia in Children

This study aimed to explore the diagnostic value of chest computed tomography (CT) based on adaptive statistical iterative reconstruction (ASiR) in the optimal weight range for children with community-acquired pneumonia (CAP) and find the differences between chest CT and ultrasound in the diagnosis of CAP. 106 children who were diagnosed as CAP were selected as the research objects. All objects underwent CT and ultrasound scans to measure the noise of CT images after iterative reconstruction and the contrast-to-noise ratio (CNR) of the thoracic aorta and the back muscles. The correlation between ASiR weight, noise, and CNR was analyzed and compared further. In addition, the differences in imaging manifestations of lung consolidation, abnormal pleural line, alveolar interstitial syndrome, and pleural effusion were observed under the ultrasound and CT scans of the patients. The sensitivity, specificity, positive predicted value (PV), and negative PV of the CT scan and ultrasound were analyzed further for the diagnosis of CAP in children. The results showed that ASiR weight and image noise were extremely and negatively correlated ( P < 0.001 ) and that CNR and ASiR weight were extremely and positively correlated ( P < 0.001 ). 40–60% of ASiR image noise was in the middle position, and the muscle space and subcutaneous fat in CT images were clearer when ASiR was at 40% and 60%. 60.38% of children were diagnosed as CAP. The proportions of children with lung consolidation, interstitial changes, pleural effusion, and atelectasis after ultrasound and CT examination were not greatly different ( P > 0.05 ). After ASiR, the sensitivity of CT in detecting the abnormal pleural line + B-line/consolidation feature was the highest, 93.75%. The results of ultrasound diagnosis were consistent with those of chest CT diagnosis ( P < 0.01 ). This indicated that the sensitivity, specificity, positive PV, and negative PV of ASiR-based chest CT in the diagnosis of CAP were close to those of ultrasound.

The importance of ultrasound in the diagnosis of pleura complications of acute destructive pneumonia in children

Background. The problem of timely diagnosis of complications of acute destructive pneumonia accompanied by pyofibrothorax remains relevant. The study was aimed to investigate the features of ultrasound diagnosis (ultrasound) of the condition of the visceral and parietal pleural lamina in acute destructive pneumonia in children at different stages of the disease. Materials and methods. In the departments of purulent surgery and pulmonology of the Regional Children’s Hospital of Dnipro for the period of 5 years, there were observed about 475 children aged from 1 to 17 years with pneumonia, purulent-destructive changes in the lungs and pleura. For analysis and further study, we choose a group of 50 patients of different age groups, who underwent ultrasound in real time without prior preparation of patients. The condition of the parietal and visceral pleural lamina at the different stages of diagnosis and treatment was studied. Results. A group of patients aged from 4 to 10 years was performed an ultrasound of the pleural cavities in real time without prior preparation on the paraspinal, scapular, axillary, midclavicular, and thoracic lines when admitted to the hospital and on the first day of treatment. Ultrasound was used to determine the structure and volume of free fluid as well as the condition of the parietal and visceral pleural lamina, their thickness, and other features. The use of ultrasound allowed diagnosing the early manifestations of pyofibrothorax and determining the condition of the parietal and visceral pleural lamina in the children with destructive pneumonia. Conclusion. Further improvement of the algorithm of ultrasound diagnosis of acute destructive pneumonia in children with pyofibrothorax will reduce radiation exposure to a child’s body, increase the efficiency of the development and improvement of treatment methods at the stages of pyofibrotorax, reduce the duration of inpatient treatment.

Interpretable modeling and discovery of key predictors for pneumonia diagnosis in children based on electronic medical records.

BackgroundCommunity-acquired pneumonia is one of the most common infectious diseases in children and is a leading cause of death among children under 5 years of age, resulting in high rates of antibiotic usage and hospitalization. It is of extremely practical significance to make full use of the existing electronic medical records to study pneumonia and to establish automatic diagnosis models for pneumonia.MethodsWe established pneumonia diagnosis models of Bayesian network using a total of 13,448 electronic medical records. We investigated learning network structure and parameter estimation and evaluated different structure learning strategies and various modeling methods. By identifying the key predictors of model, the pneumonia status was analyzed.ResultsThe performance of the proposed Bayesian network was evaluated using a set of 3361 cases with a precision of 0.7861, a recall of 0.9889, and an F1-score of 0.8759. On an independent external validation set containing 4925 cases, Bayesian network achieved a precision of 0.7382, a recall of 0.9947, and an F1-score of 0.8475. Our proposed Bayesian network outperformed all other methods, including CatBoost, XGBoost, LightGBM, logistic regression, and ridge classification.ConclusionThe appropriate feature selection improved the performance of Bayesian networks. The proposed Bayesian network had good generalizability and could be directly applied to clinical research centers. And the key predictors identified by the network demonstrated good clinical interpretability, allowing for a better understanding of pneumonia status and complications. This study had important clinical value and practical significance for the research and diagnosis of pediatric pneumonia.

Automated Diagnosis of Childhood Pneumonia in Chest Radiographs Using Modified Densely Residual Bottleneck-Layer Features

Pneumonia is a severe infection that affects the lungs due to viral or bacterial infections such as the novel COVID-19 virus resulting in mild to critical health conditions. One way to diagnose pneumonia is to screen prospective patient’s lungs using either a Computed Tomography (CT) scan or chest X-ray. To help radiologists in processing a large amount of data especially during pandemics, and to overcome some limitations in deep learning approaches, this paper introduces a new approach that utilizes a few light-weighted densely connected bottleneck residual block features to extract rich spatial information. Then, shrinking data batches into a single vector using four efficient methods. Next, an adaptive weight setup is proposed utilizing Adaboost ensemble learning which adaptively sets weight for each classifier depending on the scores generated to achieve the highest true positive rates while maintaining low negative rates. The proposed method is evaluated using the Kaggle chest X-ray public dataset and attained an accuracy of 99.6% showing superiority to other deep networks-based pneumonia diagnosis methods.