Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa

• Published in: PloS one Vol. 16; no. 8; p. e0255790
• Main Authors: Le Roux, David M, Nicol, Mark P, Vanker, Aneesa, Nduru, Polite M, Zar, Heather J
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.08.2021; Public Library of Science (PLoS)
• Subjects: Age groups; Antibiotics; Bacterial pneumonia; Biology and Life Sciences; Birth weight; Blood; C-reactive protein; C-Reactive Protein - analysis; Chest; Childbirth & labor; Children; Children & youth; Childrens health; Demographic aspects; Evaluation; Fatalities; Female; Growth Disorders - pathology; Health aspects; Health risks; HIV; HIV Infections - complications; HIV Infections - diagnosis; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Human immunodeficiency virus; Humans; Hypoxia; Incidence; Infant; Infant, Low Birth Weight; Infant, Newborn; Infants; Inflammation; Intensive care; Intensive Care Units; Leukocytes; Leukocytes (neutrophilic); Low birth weight; Male; Medical referrals; Medicine and Health Sciences; Mitigation; Mortality; Oxygen; Oxygen content; Oxygen Saturation; Patient outcomes; Pediatrics; People and Places; Pneumonia; Pneumonia - complications; Pneumonia - epidemiology; Pneumonia - mortality; Poisson density functions; Premature birth; Premature Birth - epidemiology; Prospective Studies; Radiography; Risk Factors; South Africa - epidemiology; Thorax - diagnostic imaging; Underweight; Vaccines; South Africa; Cape Town South Africa
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0255790

Child hospitalization for pneumonia remains common, and pneumonia is a major cause of child mortality. Early identification of clinical factors associated with serious outcomes may help target risk-mitigation strategies. Pneumonia cases occurring in the Drakenstein Child Health Study, a prospective birth cohort outside Cape Town, South Africa were analysed, and factors associated with serious outcomes of pneumonia were identified. Pregnant women were enrolled antenatally, followed through pregnancy, and mother-child pairs from birth to 2 years. Active surveillance for pneumonia was done. Children hospitalized with pneumonia had chest radiography and blood drawn for inflammatory markers; course, outcome and duration of hospitalization were investigated. Serious outcomes were defined as in-hospital mortality or admission to intensive care unit (ICU). Prolonged hospitalization was also explored as a proxy for severity. Features associated with serious outcomes or prolonged hospitalization were analysed using modified Poisson regression. Among 1143 live born infants, there were 174 hospitalized pneumonia events in 133 children under 2 years. Three children (1.7%) died, 14 (8%) required ICU admission for respiratory support. In modified Poisson regression, age < 2 months, preterm birth, or hypoxia (oxygen saturation <92%) were significantly associated with serious outcomes. Preterm birth, low birth weight, HIV exposure, stunting, or underweight-for-age (UWFA) were associated with prolonged hospitalization. Chest radiography, elevated C reactive protein, white blood cell and neutrophil counts were not useful to predict death or ICU admission in children hospitalized with pneumonia. In this cohort, death from pneumonia was rare, but clinical features associated with serious outcomes and prolonged hospitalization were identified. These may help with risk stratification, to identify children who may benefit from enhanced monitoring or earlier escalation to respiratory support.