Ashraf H, Jahan S A, Alam N H, Mahmud R, Kamal S M, Salam M A, Gyr N
Clinical Sciences Division, ICDDR,B, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh.
Arch Dis Child. 2008 Jun;93(6):490-4. doi: 10.1136/adc.2007.118877. Epub 2007 Sep 5.
Management of severe and very severe pneumonia in children relies on hospital-based treatment, but practical barriers often prevent children in areas with the highest rates from receiving hospital care.
To develop and prospectively evaluate a day-care clinic approach, which provided antibiotics, feeding and supportive care during the day with continued care provided by parents at home, as an effective alternative to hospitalisation.
Children aged 2-59 months with severe or very severe pneumonia without associated co-morbidities, denied admission to hospital because of lack of beds, were enrolled at Radda Clinic, Dhaka and received antibiotics, feeding and supportive care from 08:00 to 17:00 every day, while mothers were educated on continuation of care at home during the night.
From June 2003 to May 2005, 251 children were enrolled. Severe and very severe pneumonia was present in 189 (75%) and 62 (25%) children, respectively, and 143 (57%) were hypoxaemic with a mean (SD) oxygen saturation of 93 (4)%, which increased to 98 (3)% on oxygen therapy. The mean (SD) day-care period was 7 (2) days. Successful management was possible in 234 children (93% (95% CI 89% to 96%)), but 11 (4.4% (95% CI 2.5% to 7.7%)) had to be referred to hospital, and six (2.4% (95% CI 1.1% to 5.1%)) discontinued treatment. There were no deaths during the day-care study period; however, four children (1.6% (95% CI 0.6% to 4.0%)) died during the 3-month follow-up period, and 11 (4.4% (95% CI 2.5% to 7.7%)) required hospital admission.
Severe and very severe pneumonia in children without associated co-morbidities such as severe malnutrition can be successfully managed at day-care clinics.
儿童重症和极重症肺炎的治疗依赖于住院治疗，但实际障碍常常使发病率最高地区的儿童无法获得住院治疗。
开发并前瞻性评估一种日托诊所治疗方法，即白天提供抗生素、喂养及支持性治疗，由家长在家中继续护理，作为住院治疗的有效替代方案。
年龄在2至59个月、患有重症或极重症肺炎且无相关合并症、因床位不足而未被收治入院的儿童，在达卡的拉达诊所登记入组，每天08:00至17:00接受抗生素、喂养及支持性治疗，同时对母亲进行夜间在家中继续护理的教育。
2003年6月至2005年5月，共登记入组251名儿童。分别有189名（75%）和62名（25%）儿童患有重症和极重症肺炎，143名（57%）儿童存在低氧血症，平均（标准差）血氧饱和度为93（4）%，经氧疗后升至98（3）%。平均（标准差）日托治疗期为7（2）天。234名儿童（93%（95%可信区间89%至96%））治疗成功，但11名（4.4%（95%可信区间2.5%至7.7%））儿童不得不转诊至医院，6名（2.4%（95%可信区间1.1%至5.1%））儿童中断治疗。日托治疗研究期间无死亡病例；然而，4名儿童（1.6%（95%可信区间0.6%至4.0%））在3个月随访期内死亡，11名（4.4%（95%可信区间2.5%至7.7%））儿童需要住院治疗。
对于无严重营养不良等相关合并症的儿童重症和极重症肺炎，可在日托诊所成功治疗。
