Correlation between chest radiographic findings and clinical features in hospitalized children with Mycoplasma pneumoniae pneumonia.

By Yeon Jin Cho, Mi Seon Han, Woo Sun Kim, Eun Hwa Choi, Young Hun Choi, Ki Wook Yun, SeungHyun Lee, Jung-Eun Cheon, In-One Kim, Hoan Jong Lee. Published in PLOS One. August 28, 2019.   

 

Radiologic evaluation of children with Mycoplasma pneumoniae is important for diagnosis and management. To investigate the correlation between chest radiographic findings and the clinical features in children with Mycoplasma pneumoniae pneumonia. This study included 393 hospitalized children diagnosed with M. pneumoniae pneumonia between January 2000 and August 2016. Their clinical features and chest radiographs were reviewed. Radiographic findings were categorized and grouped as consolidation group (lobar or segmental consolidation) and non-consolidation group (patchy infiltration, localized reticulonodular infiltration, or parahilar peribronchial infiltration). Lobar or segmental consolidation (37%) was the most common finding, followed by parahilar or peribronchial infiltration (27%), localized reticulonodular infiltration (21%) and patchy infiltration (15%). The consolidation group was more frequently accompanied by pleural effusions (63%), compared to the non-consolidation group (16%). Compared with patients in the non-consolidation group, those in the consolidation group were associated with a significantly higher rate of hypoxia, tachypnea, tachycardia, extrapulmonary manifestations, prolonged fever, and longer periods of anti-mycoplasma therapy and hospitalization. Lobar or segmental consolidation was significantly more frequent in children ≥5 years old (44%) compared with children 2–5 years old (34%) and <2 years old (13%). Parahilar peribronchial infiltration was significantly more frequent in children <2 years old (56%) compared with children 2–5 years old (32%) and ≥5 years old (18%). The chest radiographic findings of children with M. pneumoniae pneumonia correlate well with the clinical features. Consolidative lesions were frequently observed in older children and were associated with more severe clinical features.

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Seasonal variation and etiologic inferences of childhood pneumonia and diarrhea mortality in India.

By Daniel S Farrar, Shally Awasthi, Shaza A Fadel, Rajesh Kumar, Anju Sinha, Sze Hang Fu, Brian Wahl, Shaun K Morris, and Prabhat Jha. Published in eLife. Published August 27, 2019.

 

Control of pneumonia and diarrhea mortality in India requires understanding of their etiologies. We combined time series analysis of seasonality, climate region, and clinical syndromes from 243,000 verbal autopsies in the nationally representative Million Death Study. Pneumonia mortality at 1 month-14 years was greatest in January (Rate ratio (RR) 1.66, 99% CI 1.51–1.82; versus the April minimum). Higher RRs at 1–11 months suggested respiratory syncytial virus (RSV) etiology. India’s humid subtropical region experienced a unique summer pneumonia mortality. Diarrhea mortality peaked in July (RR 1.66, 1.48–1.85) and January (RR 1.37, 1.23–1.48), while deaths with fever and bloody diarrhea (indicating enteroinvasive bacterial etiology) showed little seasonality. Combining mortality at ages 1–59 months with prevalence surveys, we estimate 40,600 pneumonia deaths from Streptococcus pneumoniae, 20,700 from RSV, 12,600 from influenza, and 7200 from Haemophilus influenzae type b and 24,700 diarrheal deaths from rotavirus occurred in 2015. Careful mortality studies can elucidate etiologies and inform vaccine introduction.

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Lung ultrasound in children with pneumonia: interoperator agreement on specific thoracic regions

By Tiago Henrique de SouzaJosé Antonio Hersan NadalEmail authorAndressa Oliveira PeixotoRicardo Mendes PereiraMarina Pavan GiattiAna Carolina Siqueira SoubMarcelo Barciela Brandão

European Journal of Pediatrics. To be published September 2019.

 

The objective of this study was to evaluate the interoperator agreement of lung ultrasonography (LUS) on specific thoracic regions in children diagnosed with pneumonia and to compare the findings of the LUS with the chest X-ray. Participants admitted to the ward or PICU underwent LUS examinations performed by an expert and a novice operator. A total of 261 thoracic regions in 23 patients were evaluated. Median age and weight of participants were 30 months and 11.6 kg, respectively. A substantial overall agreement between operators was found for normal lung tissue (κ = 0.615, 95% confidence interval (95% CI) = 0.516–0.715) and for consolidations (κ = 0.635, 95% CI = 0.532–0.738). For B-lines, a moderate agreement was observed (κ = 0.573, 95% CI = 0.475–0.671). An almost perfect agreement was found for pleural effusion (κ = 0.868, 95% CI = 0.754–0.982). The diagnosis of consolidations by LUS showed a high sensitivity (93% for both operators) but a low specificity (14% for expert and 25% for novice operator). While intubated patients presented significantly more consolidations, nonintubated patients presented more normal ultrasound patterns.

Even when performed by operators with very distinct degrees of experience, LUS had a good interoperator reliability for detecting sonographic patterns on specific thoracic regions.

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Lung ultrasound in infants with bronchiolitis.

By Danilo Buonsenso, Anna Maria Musolino, Antonio Gatto, Ilaria Lazzareschi, Antonietta Curatola & Piero Valentini

BMC Pulmonary Medicine. August 24, 2019.

 

Lung ultrasound (LUS) is nowadays a fast-growing field of study since the technique has been widely acknowledged as a cost-effective, radiation free, and ready available alternative to standard X-ray imaging. However, despite extensive acoustic characterization studies and documented medical evidences, a lot is still unknown about how ultrasounds interact with lung tissue. One of the most discussed lung artifacts are the B-lines [in all ages] and the subpleural consolidations (in young infants). Recently, LUS has been claimed to be able to detect pneumonia in infants with bronchiolitis, although this can be an overestimation due to the peculiar physiology of small peripheral airways of the pediatric lung (particularly in neonate/infants). Distinguishing consolidations from atelectasis in young infants with bronchiolitis can be challenging and those criteria well defined for adults and older children (size and bronchogram) cannot easily translated in this specific subset. Therefore, if decades of studies clearly defined the low risk of SBI in bronchiolitis, we need to be careful before stating that LUS may confirm pneumonia in such a high number of cases and, importantly, new and promising techniques such as LUS should give us new insights bringing us to improvements and not back to overuse of antibiotics. More studies are surely need on this topic.

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Critical combination of initial markers for predicting refractory Mycoplasma pneumoniae pneumonia in children: a case control study.

By Young-Jin Choi, Ju-Hee Jeon & Jae-Won Oh

Respiratory Research. August 23, 2019.

 

It is unclear whether the responses of refractory and common Mycoplasma pneumoniae (MP) pneumonia to macrolides differ. Hence, this study aimed to identify biomarkers that may be used to distinguish refractory and common pneumonias caused by MP in children at hospital admission.

The study included 123 children divided into five groups according to infection agent and treatment protocol: Group I included those with MP infection without documented viral infection, treated with only macrolides; Group II included those with MP infection without documented viral infection, treated with a combination of macrolides and methylprednisolone; Group III included those with MP infection and documented viral infection, treated with only macrolides; Group IV included those with viral pneumonia without documented MP infection; Group V was the control group composed of admitted children without MP or a documented viral infection. These five groups were further subdivided into Groups A (including Groups I, III, IV, and V) and B (Group II) according to the responses to macrolide treatment. Concentrations of cytokines interleukin 6, interleukin 17, interleukin 18, and tumor necrosis factor-α, and lactate dehydrogenase, and ferritin of all children were evaluated, and these levels were compared among the groups. Statistical comparisons were made using Kruskal Wallis test and Mann-Whitney U test.

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Effectiveness of pneumococcal conjugate vaccine against hospital admissions for pneumonia in Australian children: a retrospective, population-based, record-linked cohort study.

By Parveen Fathima, Heather F Gidding, Peter B McIntyre, Thomas L Snelling, Lisa McCallum, Nicholas de Klerk, Christopher C Blyth, Bette Liu, Hannah C Moore

The Lancet Child & Adolescent Health, August 19, 2019

 

Reductions in pneumonia hospitalisations following introduction of pneumococcal conjugate vaccines (PCVs) have been reported from high-incidence and low-incidence settings but long-term data comparing vaccinated with unvaccinated children are sparse.

We did a retrospective, population-based, record-linkage cohort study in Australian children using administrative health data from the Western Australian Midwives' Notification System and New South Wales Perinatal Data Collection, and the birth and death registries in both states. PCV vaccination details, pneumonia-coded hospital admissions, and invasive pneumococcal disease notification records were individually linked for children born between 2001 and 2012. The primary outcome was defined as the first hospital admission for all-cause pneumonia. Cox models were used to calculate adjusted hazard ratios (HR) to estimate the effect of PCV doses on pneumonia-coded hospital admissions by Aboriginal status, birth period, remoteness, and pneumonia diagnostic category in children younger than 2 years. Person-time of follow-up time for each child started at birth and was censored at the earliest of first hospital admission for all-cause pneumonia, death, invalid PCV dose, when the child reached age 24 months, or the end date of the study period (Dec 31, 2013)

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Use of Chest Radiography Examination as a Probe for PCV Impact on Lower Respiratory Tract Infections in Young Children

By Shalom Ben-Shimol,  Ron Dagan,  Noga Givon-Lavi,  Dekel Avital,  Jacob Bar-Ziv, David Greenberg

Clinical Infectious Diseases. August 15, 2019.

 

Community-acquired alveolar pneumonia (CAAP) is considered a bacterial disease, mainly pneumococcal. CAAP rates markedly declined following PCV7/PCV13 introduction worldwide. In contrast, non-CAAP lower respiratory tract infections (NA-LRI) are generally not considered pneumococcal diseases. We assessed CAAP, NA-LRI and overall rates of visits with chest radiograph (CXR) examination in the pediatrics emergency room in southern Israel before and after PCV implementation.

An ongoing, prospective observational study. Our hospital serves a captive population of ~75,000 children <5 years, enabling incidence calculation. PCV7/PCV13 were implemented in Israel in July 2009/November 2010, respectively. All CXRs were digitalized and analyzed according to the WHO Standardization of Interpretation. Annual incidences of CAAP, NA-LRI and CXR examinations\ were calculated from 2004 to 2017. Incidence-rate ratios (IRRs) comparing PCV13 (2014-2017) with pre-PCV (2004-2008) periods were calculated.

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Antibiotic Resistance Profiles of Haemophilus influenzae Isolates from Children in 2016: A Multicenter Study in China.

By Hong-Jiao Wang, Chuan-Qing Wang, Chun-Zhen Hua, Hui Yu, Ting Zhang, Hong Zhang, Shi-Fu Wang, Ai-Wei Lin, Qing Cao, Wei-Chun Huang, Hui-Ling Deng, Shan-Cheng Cao, and Xue-jun Chen. Published in The Canadian Journal of Infectious Diseases and Medical Microbiology. Published August 14, 2019.

 

Haemophilus influenzae (HI) is a common cause of community-acquired pneumonia in children. In many countries, HI strains are increasingly resistant to ampicillin and other commonly prescribed antibiotics, posing a challenge for effective clinical treatment. This study was undertaken to determine the antibiotic resistance profiles of HI isolates from Chinese children and to provide guidelines for clinical treatment. Our Infectious Disease Surveillance of Pediatrics (ISPED) collaboration group includes six children's hospitals in different regions of China. The same protocols and guidelines were used by all collaborators for the culture and identification of HI. The Kirby–Bauer method was used to test antibiotic susceptibility, and a cefinase disc was used to detect β-lactamase activity. We isolated 2073 HI strains in 2016: 83.9% from the respiratory tract, 11.1% from vaginal secretions, and 0.5% from blood. Patients with respiratory isolates were significantly younger than nonrespiratory patients (P < 0.001). Of all 2073 strains, 50.3% were positive for β-lactamase and 58.1% were resistant to ampicillin; 9.3% were β-lactamase-negative and ampicillin-resistant. The resistance rates of the HI isolates to trimethoprim-sulfamethoxazole, azithromycin, cefuroxime, ampicillin-sulbactam, cefotaxime, and meropenem were 71.1%, 32.0%, 31.2%, 17.6%, 5.9%, and 0.2%, respectively. More than half of the HI strains isolated from Chinese children were resistant to ampicillin, primarily due to the production of β-lactamase. Cefotaxime and other third-generation cephalosporins could be the first choice for the treatment of ampicillin-resistant HI infections.\

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Determinants of pneumonia among 2-59 months old children at Debre Markos referral hospital, Northwest Ethiopia: a case-control study.

By Sefinew Getaneh, Girma Alem, Maru Meseret, Yihun Miskir, Tilahun Tewabe, Gebeyaw Molla & Yihalem Abebe Belay

Published in BMC Pulmonary Medicine. August 13, 2019.  

 

Pneumonia is a significant public health problem globally. The early identification and management of the determinants of pneumonia demands clear evidence. But, there is a limited data on this issue in the current study area. Thus, this study aimed to identify the determinants of pneumonia among 2–59 months old children at Debre Markos Referral Hospital, Northwest Ethiopia. A Hospital based unmatched case-control study was conducted among 334 (167 Cases and 167 Controls) children at Debre Markos Referral Hospital from February 1 to March 30, 2018. Consecutive sampling technique was employed and data were collected with a pre-tested interviewer administered questionnaire. Data were entered into Epi-Data version 4.2, and analyzed using SPSS version 25 software. Bi-variable and multi-variable logistic regression analyses were fitted. Variables having p-value < 0.05 were considered as statistically significant. A total of 328(164 cases and 164 controls) 2–59 months old children were included in this study. Not opening windows daily [AOR:6.15(2.55,14.83)], household near to the street [AOR:4.23(1.56,11.44)], child care by the house workers and relatives [AOR:2.97 (1.11,7.93)], using only water for hand washing before child feeding [AOR:3.81 (1.51, 9.66)], mixed feeding practice from birth to six months [AOR: 7.62 (2.97, 19.55)], having upper respiratory tract infection in the last 2 weeks for the child [AOR: 5.33 (2.16, 13.19)] and children with history of co- residence with URTI family [AOR: 6.17 (2.36,16.15)] were found to be determinants of pneumonia. The main contributing factors for pneumonia in this study are preventable with no or minimal cost. Therefore, we recommend appropriate and adequate health education regarding pneumonia prevention and control.

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Use of Chest Radiography Examination as a Probe for PCV Impact on Lower Respiratory Tract Infections in Young Children

By Akshata Hopkins and Stephanie J. Doniger

Hospital Pediatrics. August 12, 2019.

 

Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.

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Making Machine Learning Models Clinically Useful

By Nigam H. Shah, Arnold Milstein, Steven C. Bagley.

JAMA. August 8, 2019.

 

Recent advances in supervised machine learning have improved diagnostic accuracy and prediction of treatment outcomes, in some cases surpassing the performance of clinicians.1 In supervised machine learning, a mathematical function is constructed via automated analysis of training data, which consists of input features (such as retinal images) and output labels (such as the grade of macular edema). With large training data sets and minimal human guidance, a computer learns to generalize from the information contained in the training data. The result is a mathematical function, a model, that can be used to map a new record to the corresponding diagnosis, such as an image to grade macular edema. Although machine learning–based models for classification or for predicting a future health state are being developed for diverse clinical applications, evidence is lacking that deployment of these models has improved care and patient outcomes.

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Is Fever a Red Flag for Bacterial Pneumonia in Children With Viral Bronchiolitis?

By Dominique Elmore, Balfaqih Yaslam, Krista Putty, Thomas Magrane, Anthony Abadir, Saloni Bhatt, Marie Frazier, and Susan Flesher

Global Pediatric Health. August 6, 2019.

 

We hypothesized that fever in children with viral bronchiolitis indicates the need for consideration of superimposed bacterial pneumonia. We conducted a retrospective study of 349 children aged 2 years and younger with diagnoses of respiratory syncytial virus (RSV) and viral upper respiratory infection. Data were analyzed using Pearson χ2 test. One hundred seventy-eight children had RSV with no other identified virus. The majority of children (56%) who had only RSV were afebrile. Febrile children with RSV were over twice as likely to be diagnosed with bacterial pneumonia as those who were afebrile (60% vs 27%, P< .001). In the 171 children who had bronchiolitis caused by a virus other than RSV, 51% were afebrile. These children were 8 times more likely to be diagnosed with pneumonia than those who were afebrile (65% vs 8%, P < .001). Evaluation of febrile children with viral bronchiolitis may allow early diagnosis and treatment of secondary bacterial pneumonia.

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Pneumococcal immunization with conjugate vaccines: are 10-valent and 13-valent vaccines similar?

By Susanna Esposito and Nicola Principi

Future Microbiology, August 2, 2019

 

No abstract available.

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Major causes of death in preterm infants in selected hospitals in Ethiopia (SIP): a prospective, cross-sectional, observational study.

By Lulu M Muhe, Elizabeth M McClure, Assaye K Nigussie, Amha Mekasha, Bogale Worku, Alemayehu Worku, Asrat Demtse, Beza Eshetu, Zemene Tigabu, Mahlet A Gizaw, Netsanet Workneh, Abayneh Girma, Mesfin Asefa, Ramon Portales, Tiruzer Bekele, Mesele Bezabih, Gesit Metaferia, Mulatu Gashaw, Bewketu Abebe, Hailu Berta, Addisu Alemu, Tigist Desta, Rahell Hailu, Goitom Gebreyesus, Sara Aynalem, Alemseged L Abdissa, Riccardo Pfister, Zelalem Tazu Bonger, Solomon Gizaw, Tamrat Abebe, Melkamu A Berhane, Yonas Bekuretsion, Sangappa Dhaded, Janna Patterson, and Robert L Goldenberg

Published in Lancet Global Health. August 2019.   

 

Neonatal deaths now account for 47% of all deaths in children younger than 5 years globally. More than a third of newborn deaths are due to preterm birth complications, which is the leading cause of death. Understanding the causes and factors contributing to neonatal deaths is needed to identify interventions that will reduce mortality. We aimed to establish the major causes of preterm mortality in preterm infants in the first 28 days of life in Ethiopia. We did a prospective, cross-sectional, observational study in five hospitals in Ethiopia. Study participants were preterm infants born in the study hospitals at younger than 37 gestational weeks. Infants whose gestational age could not be reliably estimated and those born as a result of induced abortion were excluded from the study. Data were collected on maternal and obstetric history, clinical maternal and neonatal conditions, and laboratory investigations. For neonates who died of those enrolled, consent was requested from parents for post-mortem examinations (both complete diagnostic autopsy and minimally invasive tissue sampling). An independent panel of experts established the primary and contributory causes of preterm mortality with available data. Between July 1, 2016, to May 31, 2018, 4919 preterm infants were enrolled in the study and 3852 were admitted to neonatal intensive care units. By 28 days of post-natal age, 1109 (29%) of those admitted to the neonatal intensive care unit died. Complete diagnostic autopsy was done in 441 (40%) and minimally invasive tissue sampling in 126 (11%) of the neonatal intensive care unit deaths. The main primary causes of death in the 1109 infants were established as respiratory distress syndrome (502 [45%]); sepsis, pneumonia and meningitis (combined as neonatal infections; 331 [30%]), and asphyxia (151 [14%]). Hypothermia was the most common contributory cause of preterm mortality (770 [69%]). The highest mortality occurred in infants younger than 28 weeks of gestation (89 [86%] of 104), followed by infants aged 28–31 weeks (512 [54%] of 952), 32–34 weeks (349 [18%] of 1975), and 35–36 weeks (159 [8%] of 1888). Three conditions accounted for 89% of all deaths among preterm infants in Ethiopia. Scale-up interventions are needed to prevent or treat these conditions. Further research is required to develop effective and affordable interventions to prevent and treat the major causes of preterm death.

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Acute Oxygen Therapy on Hospital Wards in Low Middle-Income Country: Experience from a Referral Centre in Ilorin, Nigeria.

By Desalu OO, Oyedepo OO, Ojuawo OB, Ibraheem M, Aladesanmi AO, Suleiman ZA, Opeyemi CM, Adesina KT, Sanya EO, Salami AK. Published in West African Journal of Medicine. August 1, 2019.   

 

Oxygen is like any other medication that can cause severe consequences if administered inappropriately.To audit the pattern of acute oxygen therapy on regular hospital wards of a referral centre in Ilorin, Nigeria. We reviewed 150 patients that received or had a prescription for acute oxygen therapy in three months and extracted relevant information using a proforma. About one-third of the patients (30%) were >65 years of age and the male to female ratio was 1:1. The commonest indication and medical condition for acute oxygen administration were hypoxemia (70.7%) and pneumonia (26.0%), respectively. Pneumonia accounted for most (41.2 %) of the oxygen therapy in childhood. The majority of patients (88.0%) had written order for oxygen prescription, 40.7% had a prescription to target oxygen saturation and only 31.3% achieved their target saturation. Oxygen prescription was adequate (documentation of delivery device, flow rate of oxygen, and target oxygen saturations) in 40.7% of patients. The assessment, monitoring and titration of oxygen therapy were adequate in 92.7%, 65.3% and 28 % of patients respectively. Overall mortality was 27.3% in patients receiving acute oxygen supplementation. Eleven patients had unstable COPD, and 63.6 %, 54.5 % and 45.6 % of them had adequate oxygen prescription, monitoring and titration respectively. The challenges to oxygen use were faulty delivery devices, emptied oxygen cylinders, inability to routinely do arterial blood gas analysis and lack of hospital oxygen protocol. The current practice of acute oxygen therapy is not satisfactory and interventions are advocated to improve the healthcare providers' administration of oxygen.

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Pediatric Respiratory Illness Measurement System (PRIMES) Scores and Outcomes.

By Rita Mangione-Smith, Chuan Zhou, Derek J. Williams, David P. Johnson, Chén C. Kenyon, Amy Tyler, Ricardo Quinonez, Joyee Vachani, Julie McGalliard, Joel S. Tieder, Tamara D. Simon, Karen M. Wilson, for the Pediatric Research in Inpatient Settings (PRIS) Network

Pediatrics. August 2019.

 

The Pediatric Respiratory Illness Measurement System (PRIMES) generates condition-specific composite quality scores for asthma, bronchiolitis, croup, and pneumonia in hospital-based settings. We sought to determine if higher PRIMES composite scores are associated with improved health-related quality of life, decreased length of stay (LOS), and decreased reuse.

We conducted a prospective cohort study of 2334 children in 5 children’s hospitals between July 2014 and June 2016. Surveys administered on admission and 2 to 6 weeks postdischarge assessed the Pediatric Quality of Life Inventory (PedsQL). Using medical records data, 3 PRIMES scores were calculated (0–100 scale; higher scores = improved adherence) for each condition: an overall composite (including all quality indicators for the condition), an overuse composite (including only indicators for care that should not be provided [eg, chest radiographs for bronchiolitis]), and an underuse composite (including only indicators for care that should be provided [eg, dexamethasone for croup]). Multivariable models assessed relationships between PRIMES composite scores and (1) PedsQL improvement, (2) LOS, and (3) 30-day reuse.

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Exploratory meeting to review new evidence for Integrated Management of Childhood Illness danger signs

IMCI-danger-sign_20190809-151341_1

The World Health Organization, August 1, 2019

 

For children up to 5 years of age with common childhood illnesses, WHO’s IMCI strategy recommends using clinical signs for diagnosis, treatment and place-of-treatment decisions. In order to increase access to pneumonia treatment, in 2014 WHO revised pneumonia management guidance within IMCI. It now recommends that lower chest indrawing, which previously required hospitalization along with other referral clinical signs considered as danger signs for injectable antibiotics, be treated with oral amoxicillin on an outpatient basis in settings with low HIV prevalence. These danger signs include convulsions; unable to drink; unconscious or drowsy; vomiting everything; stiff neck; severe dehydration; stridor in a calm child; oedema on both feet; weight for height (WHZ) Z-score less than - 3 SD or mid-upper arm circumference (MUAC) less than 115 mm; severe palmar pallor; clouding of the cornea in a child with measles, and tender swelling behind the ear in a child with an ear problem.

 

However, a recent retrospective analysis of data from hospitalized children in Kenya showed that mortality was high among children with mild to moderate palmar pallor, WAZ less than - 3 SD and lower chest indrawing. This finding raised concerns that these children should be treated on an inpatient basis despite the revised guidelines. In order to evaluate the implications of this new evidence and other data and to identify questions for future research, a two-day exploratory meeting of pneumonia research experts, epidemiologists and child health specialists/paediatricians from a range of countries with varying resources was convened in Geneva, Switzerland, on 4–5 September 2018.

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Fighting for breath: how we can win the battle against childhood pneumonia

Fighting-for-breath

Photo above, by ALAMY. Article written by Tedros Adhanom Ghebreyesus

"Most people reading this article will think of pneumonia as a threat to the lives of elderly people in rich countries. We invite you to think again. Today, pneumonia is the single biggest killer of children in developing countries - and it is time for the international community to come together and combat the disease

Pneumonia claims the lives of more than 800,000 children every year, making it the biggest infectious killer of under-fives. Almost all these fatalities are preventable. Yet with relentless predictability, the death-toll continues – claiming more than 100 young lives every hour. 

Most of the victims are less than two years old. Every death leaves grieving parents forced to watch helplessly as their children fight for breath against a disease that attacks their lungs and starves their bodies of oxygen. 

Stopping pneumonia is not a complex scientific challenge. Effective vaccines can prevent the most common causes of the disease. Early and accurate diagnosis, followed by treatment with a three-day course of antibiotics costing just 25 cents would cure most cases. For children with more severe cases, treatment with oxygen and higher levels of antibiotics offer a route to recovery..." 

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Clinical Outcomes of Pneumonia and Other Comorbidities in Children Aged 2-59 Months in Lilongwe, Malawi: Protocol for the Prospective Observational Study "Innovative Treatments in Pneumonia

By Amy Sarah Ginsburg, Susanne May, Evangelyn Nkwopara, Gwen Ambler, Eric D McCollum, Tisungane Mvalo, Ajib Phiri, Norman Lufesi

Published in JMIR Respiratory Protocols. July 29, 2019.  

 

Pneumonia is the leading infectious cause of death worldwide among children below 5 years of age. Clinical trials are conducted to determine optimal treatment; however, these trials often exclude children with comorbidities and severe illness.Given the paucity of data from Africa, African-based research is necessary to establish optimal management of childhood pneumonia in malaria-endemic settings in the region. An expanded evidence base that includes children with pneumonia and other comorbidities, who are at high risk for mortality or have other complications and are therefore typically excluded from childhood pneumonia clinical trials, can contribute to future iterations of the World Health Organization Integrated Management of Childhood Illness guidelines.The study enrolled 1000 children with pneumonia presenting to the outpatient departments of Kamuzu Central or Bwaila District Hospitals in Lilongwe, Malawi, who were excluded from concurrent randomized controlled clinical trials investigating fast breathing and chest indrawing pneumonia and who met the inclusion criteria for this prospective observational study. Each child received standard care for their illnesses per Malawian guidelines and hospital protocol and was prospectively followed up with scheduled study visits on days 1, 2 (if hospitalized), 6, 14 (in person), and 30 (by phone). Our primary objectives are to describe the clinical outcomes of children who meet the inclusion criteria for this study and to investigate whether the percentages of children cured at day 14 among those with either fast breathing or chest indrawing pneumonia and comorbidities such as severe malaria, anemia, severe acute malnutrition, or HIV are lower than those in children without these comorbidities in the standard care groups in concurrent clinical trials. This study was approved by the Western Institutional Review Board, Malawi College of Medicine Research and Ethics Committee, and the Malawi Pharmacy, Medicines and Poisons Board. This prospective observational study aimed to assess the clinical outcomes of children aged 2-59 months with both pneumonia and other comorbidities in a malaria-endemic region of Malawi. The Innovative Treatments in Pneumonia project was funded by the Bill and Melinda Gates Foundation (OPP1105080) in April 2014. Enrollment in this study began in 2016, and the primary results are expected in 2019.

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August 2019 Member Newsletter

CH1225830

Above photo by Jonathan Hyams / Save the Children. Dr Partha Pratim Das attends to Sohai*, two, on the inpatient ward at Save the Children’s primary healthcare centre (PHCC) in Cox’s Bazar, Bangladesh. His mother, Laila*, brought Sohai to the PHCC when he had difficulty breathing. He was immediately admitted as an emergency case of acute pneumonia.

 

A COMMENT FROM THE COORDINATOR

 

This newsletter is about pneumonia treatment guidelines.  We are happy to share a new blog post from Dr. Todd Florin who discusses his approach to research aimed at improving pneumonia treatment for children.

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