Basnet Sudha, Sharma Arun, Mathisen Maria, Shrestha Prakash Sunder, Ghimire Ram Kumar, Shrestha Dhiraj Man, Valentiner-Branth Palle, Sommerfelt Halvor, Strand Tor A
Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway.
Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
PLoS One. 2015 Mar 23;10(3):e0122052. doi: 10.1371/journal.pone.0122052. eCollection 2015.
Pneumonia in young children is still the most frequent cause of death in developing countries. We aimed to identify predictors for recovery and treatment failure in children hospitalized with severe pneumonia.
We enrolled 610 Nepalese children, aged 2 - 35 months from February 2006 to June 2008. Study participants were provided with standard treatment for pneumonia and followed up until discharge. Three multiple regression models representing clinical variables, clinical and radiological combined and all variables, including C-reactive protein (CRP) and viral etiology were used to assess the associations.
The median age of study participants was 6 months with 493 (82%) infants and 367 (61%) males. The median time (IQR) till recovery was 49 (31, 87) hours and treatment failure was experienced by 209 (35%) of the children. Younger age, hypoxia on admission and radiographic pneumonia were independent predictors for both prolonged recovery and risk of treatment failure. While wasting and presence of any danger sign also predicted slower recovery, Parainfluenza type 1 isolated from the nasopharynx was associated with earlier resolution of illness. Gender, being breastfed, stunting, high fever, elevated CRP, presence of other viruses and supplementation with oral zinc did not show any significant association with these outcomes.
Age, hypoxia and consolidation on chest radiograph were significant predictors for time till recovery and treatment failure in children with severe pneumonia. While chest radiograph is not always needed, detection and treatment of hypoxia is a crucial step to guide the management of hospitalized children with pneumonia.
在发展中国家，幼儿肺炎仍是最常见的死亡原因。我们旨在确定重症肺炎住院儿童康复和治疗失败的预测因素。
我们纳入了2006年2月至2008年6月期间610名年龄在2至35个月的尼泊尔儿童。研究参与者接受了肺炎标准治疗，并随访至出院。使用三个多元回归模型，分别代表临床变量、临床与放射学综合变量以及所有变量（包括C反应蛋白（CRP）和病毒病因）来评估相关性。
研究参与者的中位年龄为6个月，其中493名（82%）为婴儿，367名（61%）为男性。恢复的中位时间（四分位间距）为49（31，87）小时，209名（35%）儿童经历了治疗失败。年龄较小、入院时缺氧和放射性肺炎是恢复时间延长和治疗失败风险的独立预测因素。消瘦和存在任何危险体征也预示恢复较慢，从鼻咽部分离出的1型副流感病毒与疾病的早期缓解相关。性别、母乳喂养、发育迟缓、高烧、CRP升高、存在其他病毒以及口服锌补充剂与这些结果均无显著关联。
年龄、缺氧和胸部X光片上的实变是重症肺炎儿童恢复时间和治疗失败的重要预测因素。虽然并非总是需要胸部X光片，但检测和治疗缺氧是指导住院肺炎儿童管理的关键步骤。
