A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China
Background Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care. Objective To prospectively determine PICU CAP admission features and outcomes. Methods A 4 year prosp...
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Published in | Pediatric pulmonology Vol. 48; no. 4; pp. 390 - 397 |
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Format | Journal Article |
Language | English |
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Abstract | Background
Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care.
Objective
To prospectively determine PICU CAP admission features and outcomes.
Methods
A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics.
Results
Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co‐morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3–27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings.
Conclusions
Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Pediatr Pulmonol. 2013; 48:390–397. © 2012 Wiley Periodicals, Inc. |
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AbstractList | Abstract
Background
Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care.
Objective
To prospectively determine PICU CAP admission features and outcomes.
Methods
A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics.
Results
Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co‐morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3–27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%,
Streptococcus pneumoniae
7%,
Haemophilus influenza b
4%,
Mycoplasma
11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings.
Conclusions
Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Pediatr Pulmonol. 2013; 48:390–397. © 2012 Wiley Periodicals, Inc. BACKGROUNDPneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care. OBJECTIVETo prospectively determine PICU CAP admission features and outcomes. METHODSA 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics. RESULTSEight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co-morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3-27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings. CONCLUSIONSYoung age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Background Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care. Objective To prospectively determine PICU CAP admission features and outcomes. Methods A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics. Results Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76%≤12 months) and 33% had co-morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3-27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings. Conclusions Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Pediatr Pulmonol. 2013; 48:390-397. © 2012 Wiley Periodicals, Inc. [PUBLICATION ABSTRACT] Background Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care. Objective To prospectively determine PICU CAP admission features and outcomes. Methods A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics. Results Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co‐morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3–27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings. Conclusions Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. Pediatr Pulmonol. 2013; 48:390–397. © 2012 Wiley Periodicals, Inc. Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be determined to optimize care. To prospectively determine PICU CAP admission features and outcomes. A 4 year prospective study of CAP aged 1 month to <14 years admitted to PICU, Children's Hospital Affiliated to Soochow University, China. All were managed in a standard manner. Clinical, laboratory, and imaging findings were collected systematically. All received antibiotics. Eight hundred ten (7%) of 10,836 CAP hospital admissions needed PICU. Seven hundred seven (87%) were enrolled. PICU CAP children were young (76% ≤ 12 months) and 33% had co-morbid conditions; 21% congenital heart disease.21% required mechanical ventilation. The average length of PICU stay was 5 days (range, 3-27). The case fatality rate was 5.8%. Viruses were detected in 38%, RSV 24%; bacteria in 23%, Streptococcus pneumoniae 7%, Haemophilus influenza b 4%, Mycoplasma 11%. On single factor analysis, PICU admission respiratory rate >70/min, grunting/groaning, head nodding, cyanosis, and anemia were associated with respiratory failure and with fatality. On multivariate analysis only presence of congenital heart disease, Trisomy 21 and immunodeficiency correlated with fatality; not microbe nor PICU findings. Young age and underlying congenital heart disease were associated factors for PICU support in CAP in China. Early referral if altered sensorium, high respiratory rate, head nodding, grunting and anemia, and universal access to conjugated vaccines may decrease morbidity and mortality. |
Author | Bai, Zhenjiang Guo, Zhongqin MacDonald, Noni E. Zhang, Qingli |
AuthorAffiliation | 2 Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou, Jiangsu, P.R. China 3 Department of Public Health, Ningxia Medical University, Yinchuan, P.R. China 4 Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada 1 Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China |
AuthorAffiliation_xml | – name: 2 Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou, Jiangsu, P.R. China – name: 3 Department of Public Health, Ningxia Medical University, Yinchuan, P.R. China – name: 1 Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China – name: 4 Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada |
Author_xml | – sequence: 1 givenname: Qingli surname: Zhang fullname: Zhang, Qingli organization: Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China – sequence: 2 givenname: Zhongqin surname: Guo fullname: Guo, Zhongqin organization: Department of Public Health, Ningxia Medical University, Yinchuan, P.R. China – sequence: 3 givenname: Zhenjiang surname: Bai fullname: Bai, Zhenjiang organization: Pediatric Intensive Care Unit, Children's Hospital Affiliated to Soochow University, Suzhou, Jiangsu, P.R. China – sequence: 4 givenname: Noni E. surname: MacDonald fullname: MacDonald, Noni E. email: noni.macdonald@dal.ca organization: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/22778084$$D View this record in MEDLINE/PubMed |
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Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP... Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP need to be... Abstract Background Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with... Background Pneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP... BACKGROUNDPneumonia is the major cause of death under 5 years. With high CAP numbers in China and growing access to PICUs, factors associated with severe CAP... |
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SubjectTerms | acute lower respiratory tract infection Adolescent Cardiovascular disease Child Child, Preschool children China China - epidemiology Community acquired pneumonia Community-Acquired Infections - etiology Community-Acquired Infections - mortality Community-Acquired Infections - therapy Critical Care - methods Critical Care - statistics & numerical data developing country Fatalities Female Hospitalization - statistics & numerical data hospitalized Hospitals, Pediatric - statistics & numerical data Humans Infant intensive care Intensive Care Units, Pediatric - statistics & numerical data Logistic Models Male Multivariate analysis Original : Respiratory Infections Pneumonia - etiology Pneumonia - mortality Pneumonia - therapy Prospective Studies Risk Factors Severity of Illness Index Streptococcus infections Treatment Outcome |
Title | A 4 year prospective study to determine risk factors for severe community acquired pneumonia in children in southern China |
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