International Centre for Diarrhoeal Disease Research, Bangladesh, Clinical Sciences Division, 68 Shaheed Tajuddin Ahmed Sharani, Mohakhali, Dhaka 1212, Bangladesh.
Pediatrics. 2010 Oct;126(4):e807-15. doi: 10.1542/peds.2009-3631. Epub 2010 Sep 20.
A randomized controlled trial compared day care versus hospital care management of pneumonia.
Children 2 to 59 months of age with severe pneumonia received either day care, with antibiotic treatment, feeding, and supportive care from 8:00 am to 5:00 pm, or hospital care, with similar 24-hour treatment.
In 2006-2008, 360 children were assigned randomly to receive either day care or hospital care; 189 (53%) had hypoxemia, with a mean±SD oxygen saturation of 93±4%, which increased to 99±1% after oxygen therapy. The mean±SD durations of day care and hospital care were 7.1±2.3 and 6.5±2.8 days, respectively. Successful management was possible for 156 (87.7% [95% confidence interval [CI]: 80.9%-90.9%]) of 180 children in the day care group and 173 (96.1% [95% CI: 92.2%-98.1%]) of 180 children in the hospital care group (P=.001). Twenty-three children in the day care group (12.8% [95% CI: 8.7%-18.4%] and 4 children in the hospital care group (2.2% [95% CI: 0.9%-5.6%] required referral to hospitals (P<.001). During the follow-up period, 22 children in the day care group (14.1% [95% CI: 9.5%-20.4%]) and 11 children in the hospital care group (6.4% [95% CI: 3.6%-11%]) required readmission to hospitals (P=.01). The estimated costs per child treated successfully at the clinic and the hospital were US$114 and US$178, respectively.
Severe childhood pneumonia without severe malnutrition can be successfully managed at day care clinics, except for children with hypoxemia who require prolonged oxygen therapy.
一项随机对照试验比较了儿童肺炎日间护理与住院护理管理。
年龄在 2 至 59 个月、患有严重肺炎的儿童，接受了日间护理，包括抗生素治疗、喂养和从上午 8 点到下午 5 点的支持性护理，或接受了住院护理，包括类似的 24 小时治疗。
2006 年至 2008 年，360 名儿童被随机分配接受日间护理或住院护理；189 名（53%）存在低氧血症，平均血氧饱和度为 93±4%，经氧疗后增加至 99±1%。日间护理和住院护理的平均持续时间分别为 7.1±2.3 天和 6.5±2.8 天。在日间护理组的 180 名儿童中，有 156 名（87.7%[95%置信区间：80.9%-90.9%]）和在住院护理组的 180 名儿童中，有 173 名（96.1%[95%置信区间：92.2%-98.1%]）成功管理（P=.001）。日间护理组有 23 名儿童（12.8%[95%置信区间：8.7%-18.4%]）和住院护理组有 4 名儿童（2.2%[95%置信区间：0.9%-5.6%]）需要转诊至医院（P<.001）。在随访期间，日间护理组的 22 名儿童（14.1%[95%置信区间：9.5%-20.4%]）和住院护理组的 11 名儿童（6.4%[95%置信区间：3.6%-11%]）需要再次住院（P=.01）。在诊所和医院成功治疗每名儿童的估计费用分别为 114 美元和 178 美元。
无严重营养不良的严重儿童肺炎可在日间护理诊所成功管理，除了需要长时间氧疗的低氧血症儿童。
