Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine and Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Save the Children, Seattle, Washington.
Clin Infect Dis. 2017 Oct 16;65(9):1560-1564. doi: 10.1093/cid/cix543.
This Viewpoints article details our recommendation for the World Health Organization Integrated Management of Childhood Illness guidelines to consider additional referral or daily monitoring criteria for children with chest indrawing pneumonia in low-resource settings. We review chest indrawing physiology in children and relate this to the risk of adverse pneumonia outcomes. We believe there is sufficient evidence to support referring or daily monitoring of children with chest indrawing pneumonia and signs of severe respiratory distress, oxygen saturation <93% (when not at high altitude), moderate malnutrition, or an unknown human immunodeficiency virus (HIV) status in an HIV-endemic setting. Pulse oximetry screening should be routine and performed at the earliest point in the patient care pathway as possible. If outpatient clinics lack capacity to conduct pulse oximetry, nutritional assessment, or HIV testing, then we recommend considering referral to complete the evaluation. When referral is not possible, careful daily monitoring should be performed.
这篇观点文章详细介绍了我们对世界卫生组织儿童疾病综合管理指南的建议，即在资源匮乏环境下，考虑为有胸凹陷性肺炎的儿童增加额外的转介或每日监测标准。我们回顾了儿童胸凹陷性肺炎的生理学，并将其与不良肺炎结局的风险联系起来。我们认为，有足够的证据支持对有胸凹陷性肺炎和严重呼吸窘迫迹象、血氧饱和度<93%（非高海拔地区）、中度营养不良或在艾滋病毒流行地区不明人类免疫缺陷病毒（HIV）状态的儿童进行转介或每日监测。脉搏血氧仪筛查应作为常规检查，并尽可能在患者护理路径的最早点进行。如果门诊缺乏进行脉搏血氧仪、营养评估或 HIV 检测的能力，那么我们建议考虑转介以完成评估。如果无法转介，则应进行仔细的每日监测。
