ASSOCIATION OF HAEMATOLOGICAL AND RADIOLOGICAL FINDINGS WITH CLINICAL OUTCOME IN HOSPITALIZED CHILDREN 2–36 MONTHS OLD WITH SEVERE LOWER RESPIRATORY TRACT INFECTION

Rehmana Waris, Yasir Bin Nisar, Naseera Bhatti

Abstract


Background: Despite reduction in child mortality during last decade, lower respiratory tract infection (LRTI) remained number one killer of under-five. The current study aimed to assess the association of haematological and radiological findings with clinical outcome in hospitalized children 2-36 months old with severe LRTI. Methods: In the current cross sectional study, 581 children 2-36 months old with severe LRTI were enrolled and followed at the Children Hospital, Islamabad, between 2011 and 2014. At the time of enrolment, complete history of present illness, anthropometric measurements, blood sample and chest radiograph were obtained. The primary outcome was either early clinical response (within 72 hours) or delayed clinical response (>72 hours). Multivariable logistic regression was performed to examine the association between haematological and radiological findings with clinical outcome, adjusted for potential confounding factors. Results: Of 581 enrolled children, 292 (50.3%) children had early, and 289 (49.7%) had delayed clinical response. The multivariable logistic regression showed that leucocytosis (OR 1.79, 95% CI 1.15–2.79), neutrophilia (OR 1.91, 95% CI 1.29–2.84), radiological interstitial pneumonia (OR 2.49, 95%CI 1.70–3.64), and lobar consolidation (OR 6.00, 95%CI 2.41–14.96) were significantly associated with delayed clinical response, after adjusted for potential confounding factors. Conclusions: Delayed clinical response was significantly associated with abnormal haematological and radiological findings at the time of admission in children 2-36 months old with severe LRTI. Haematological and radiological findings at the time of presentation are useful for predicting delayed clinical response in children 2-36 months old with severe LRTI.Keywords: Lower respiratory tract infection, clinical response, radiological findings, haematological findings, Clinical severity score system

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Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE, et al. Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000. Lancet 2012;379(9832):2151–61.

Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, et al. Global burden of childhood pneumonia and diarrhoea. Lancet 2013;381(9875):1405–16.

Mandell LA, Marrie TJ, Grossman RF, Chow AW, Hyland RH. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian Community-Acquired Pneumonia Working Group. Clin Infect Dis 2000;31(2):383–421.

Furer V, Raveh D, Picard E, Goldberg S, Izbicki G. Absence of leukocytosis in bacteraemic pneumococcal pneumonia. Prim Care Respir J 2011;20(3):276–81.

Nacul LC, Kirkwood BR, Carneiro AC, Pannuti CS, Magalhaes M, Arthur P. Aetiology and clinical presentation of pneumonia in hospitalized and outpatient children in Northeast Brazil and risk factors for severity. J Health Popul Nutr 2005;23(1):6–15.

Don M, Fasoli L, Paldanius M, Vainionpaa R, Kleemola M, Raty R, et al. Aetiology of community-acquired pneumonia: serological results of a paediatric survey. Scand J Infect Dis 2005;37(11-12):806–12.

Michelow IC, Olsen K, Lozano J, Rollins NK, Duffy LB, Ziegler T, et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004;113(4):701–7.

Banajeh SM. Outcome for children under 5 years hospitalized with severe acute lower respiratory tract infections in Yemen: a 5 year experience. J Trop Pediatr 1998;44(6):343–6.

Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis 1992;145(1):106–9.

Hazir T, Qazi S, Nisar YB, Ansari S, Maqbool S, Randhawa S, et al. Assessment and management of children aged 1-59 months presenting with wheeze, fast breathing, and/or lower chest indrawing; results of a multicentre descriptive study in Pakistan. Arch Dis Child 2004;89(11):1049–54.

Nisar YB, Aurangzeb B, Hazir T. Nutritional Status of Hospitalized Children with Nutritional Anaemia: A Cross Sectional Study. Ann Pak Inst Med Sci 2013;9(3):122–5.

World Health Organization. Nutrition Landscape Information System (NLIS). Country profile indicators: interpretation guide. Nutr Landsc Inf Syst NLIS Geneva WHO. 2010.

World Health Organization. Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers. Geneva: WHO. 2001.

Lwanga SK, Lemishow S. Sample size determination in health studies. Geneva: World Health Organisation, 1991.

Bharti B, Kaur L, Bharti S. Role of chest X-ray in predicting outcome of acute severe pneumonia. Indian Pediatr 2008;45(11):893–8.

Clark JE, Hammal D, Spencer D, Hampton F. Children with pneumonia: how do they present and how are they managed? Arch Dis Child 2007;92(5):394–8.

Elidin K, Salih MA. Radiological Findings in Severe Pneumonia in Children 1-59 Months in a Children’s Hospital, Khartoum, Sudan. Pediatr Ther 2012;2(3):117.

Lin CJ, Chen PY, Huang FL, Lee T, Chi CS, Lin CY. Radiographic, clinical, and prognostic features of complicated and uncomplicated community-acquired lobar pneumonia in children. J Microbiol Immunol Infect 2006;39(6):489–95.

Virkki R, Juven T, Rikalainen H, Svedstrom E, Mertsola J, Ruuskanen O. Differentiation of bacterial and viral pneumonia in children. Thorax 2002;57(5):438–41.

Grafakou O, Moustaki M, Tsolia M, Kavazarakis E, Mathioudakis J, Fretzayas A, et al. Can chest X-ray predict pneumonia severity? Pediatr Pulmonol 2004;38(6):465–9.

Watanakunakorn C, Bailey TA. Adult bacteremic pneumococcal pneumonia in a community teaching hospital, 1992-1996. A detailed analysis of 108 cases. Arch Intern Med 1997;157(17):1965–71.

Rahav G, Toledano Y, Engelhard D, Simhon A, Moses AE, Sacks T, et al. Invasive pneumococcal infections. A comparison between adults and children. Medicine (Baltimore) 1997;76(4):295–303.

Toikka P, Virkki R, Mertsola J, Ashorn P, Eskola J, Ruuskanen O. Bacteremic pneumococcal pneumonia in children. Clin Infect Dis 1999;29(3):568–72.


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