Aetiology and risks factors associated with the fatal outcomes of childhood pneumonia among hospitalised children in the Philippines from 2008 to 2016: a case series study

Abstract

ObjectivePneumonia remains the leading cause of hospitalisations and deaths among children aged <5 years. Diverse respiratory pathogens cause acute respiratory infections, including pneumonia. Here, we analysed viral and bacterial pathogens and risk factors associated with death of hospitalised children.DesignA 9-year case series study.SettingTwo secondary-care hospitals, one tertiary-care hospital and one research centre in the Philippines.Participants5054 children aged <5 years hospitalised with severe pneumonia.MethodsNasopharyngeal swabs for virus identification, and venous blood samples for bacterial culture were collected. Demographic, clinical data and laboratory findings were collected at admission time. Logistic regression analyses were performed to identify the factors associated with death.ResultsOf the enrolled patients, 57% (2876/5054) were males. The case fatality rate was 4.7% (238/5054), showing a decreasing trend during the study period (p<0.001). 55.0% of the patients who died were either moderately or severely underweight. Viruses were detected in 61.0% of the patients, with respiratory syncytial virus (27.0%) and rhinovirus (23.0%) being the most commonly detected viruses. In children aged 2–59 months, the risk factors significantly associated with death included age of 2–5 months, sensorial changes, severe malnutrition, grunting, central cyanosis, decreased breath sounds, tachypnoea, fever (≥38.5°C), saturation of peripheral oxygen <90%, infiltration, consolidation and pleural effusion on chest radiograph.Among the pathogens, adenovirus type 7, seasonal influenza A (H1N1) and positive blood culture for bacteria were significantly associated with death. Similar patterns were observed between the death cases and the aforementioned factors in children aged <2 months.ConclusionMalnutrition was the most common factor associated with death and addressing this issue may decrease the case fatality rate. In addition, chest radiographic examination and oxygen saturation measurement should be promoted in all hospitalised patients with pneumonia as well as bacteria detection to identify patients who are at risk of death.

Epidemiology and Seasonality of Childhood Respiratory Syncytial Virus Infections in the Tropics

“…In some studies, RSV detection was more than 3 times greater than the next leading pathogen [ 14 ]. Reported RSV positivity rates in tropical Asian countries range from 9% to 50% depending on the geographic location and sample population ( Table 1 ) [ 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ]. Not unexpectedly, an increased risk for RSV infection has been noted in infants with chronic lung disease, neurodevelopmental conditions and congenital heart disease, with repeated infections associated with asthma and atopy among the children and their families [ 15 ].…”

Severe Pneumonia with and without Adenovirus Infection in Children Under the Age of 5 in Guangzhou, 2009-2019: A Retrospective Cohort Study

“…Tsou showed patients with underlying condition, especially neurologic diseases were more likely suffering ADV infections (23). One study about risk factors associated with mortality of pneumonia children reported malnutrition was the most common factor related with fatality (24). The study of Zampoli et al in South Arica reported that ADV associated pneumonia children reported 34.0% were malnourished (25).…”

Neumonía en lactantes de 6 meses de edad y menores

“…Esta cifra es más elevada de la observada en otras series, como en (12) el estudio de Fritz CQ et al donde la frecuencia de choque en niños que requirieron hospitalización fue del 30%. De los datos laboratoriales, la frecuencia de trombocitopenia<150000/mm³ y la anemia severa (Hb ≤ 8 gr/dl) fueron más frecuentes en aquellos pacientes que se hospitalizaron en UCI, lo cual ya fue (21) observada en otros estudios .…”

“…Los pacientes que fallecieron fueron los de menor edad (≤3 meses), tuvieron neumonía grave (complicada con derrame pleural o neumotorax), ingresaron en choque o con insuficiencia respiratoria. Este cuadro clínico es característico de pacientes que (12,21) se hospitalizaron en UCI en otras series .…”