Predictors of Mortality among Hospitalized Children aged 2 to Less than 60 Months with Severe and Very Severe Pneumonia in Urban Tertiary Referral Health Care

Loganayaki, R (2012) Predictors of Mortality among Hospitalized Children aged 2 to Less than 60 Months with Severe and Very Severe Pneumonia in Urban Tertiary Referral Health Care. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: Pneumonia, a pandemic killer is an inflammation of the parenchyma of the lungs. Although most cases of pneumonia are caused by microorganisms, non infectious causes include aspiration of food or gastric contents, foreign bodies, hydrocarbons, lipoid substances and drug or radiation induced pneumonia[1]. For those pneumonias caused by non infectious agents the term pneumonitis is preferred. EPIDEMIOLOGY: Pneumonia is a substantial cause of morbidity and mortality among children < 5 yr of age throughout the world. Recent estimates from the World Health Organization suggest that pneumonia is responsible for 19% of deaths in the above age group, leading to 3 million deaths per year. Of these deaths, two thirds occur during infancy and more than 90% occur in the developing countries[2,3]. [In India, recent estimates in under-fives suggest that 13% of deaths and 24% of National Burden of Disease is due to pneumonia[4]. Hospital based studies have reported that 20–30% of admissions in under-fives are due to pneumonia. Case fatality rates in hospitalized children are reported to be between 8.7–47%. AIM OF THE STUDY: To find out the predictive factors of mortality among children aged 2 months to < 60 months hospitalized with severe and very severe pneumonia with radiological confirmation. DISCUSSION: Pneumonia, a forgotten killer of community is more common among children less than five years of age. Various risk factors have been identified and studied by a lot in different settings. Yet we are not able to get it under control. This study has been done to study the predictive factors of death in our community, so that we a step towards achievement of under five mortality reduction as majority is contributed by pneumonia. We did a nested case control study to identify the clinical and laboratory parameters associated with mortality in under five children hospitalized with WHO defined severe and very pneumonia. A total of 302 children with severe and very severe pneumonia were enrolled in the study. In that 194(64.2%) children had very severe pneumonia and 108(35.8%) children had severe pneumonia which is comparable with the study of Tiewosh et al. 96(31.8%) children were exposed to environmental tobacco smoke, 59(19.5%) children live in indoor polluted homes, 54(17.8%) had received exclusive breast feeding, 73(24.15%) were reared bad child rearing practices, 162(53.6%) were not yet received measles vaccination, 99(32.8%) had low birth weight [2-2.5 kg] We observed a mortality rate of 25.1% which was comparable to study of sehgal, Agarwal and Patwari et al[5,6,7]. WHO report 2006 on under five deaths highlights that children not breast fed in the first six months of life were five times more prone to suffer from pneumonia. In the present study, lack of exclusive breastfeeding was identified to be an important determinant associated with mortality in severe pneumonia which is comparable with the study of fonaseca et al, shah et al, Broor S et al, Victoria CG et al[19,23,36]. Breast milk seems to affect the infant's systemic immune system via multiple mechanisms including maturational, anti-inflammatory, immune modulatory and antimicrobial action[38]. Changes in immune phenotype after exposure to breast milk, including increase in post-vaccination interferon alpha levels and in natural killer cell numbers could result in prolonged protection against respiratory infections. In addition, there is experimental evidence in animals that maternal milk lymphocytes crosses the infant's intestinal wall barrier and enters the circulation[39]. It activates the infant's immune system. Anti-inflammatory cytokines such as interleukin-10 and transforming growth factor β are also present in breast milk and taken up by neonatal tissues, in which they are associated with a reduction in inflammatory immune responses[40] and enhanced secretary immunoglobulin A synthesis[41,42]. These findings of infant immune responses associated with breastfeeding lend biological credence to the findings in our study, in that breastfeeding could result in a decrease in respiratory infections for many months or even years. CONCLUSION: In a study of severe and very severe pneumonia in children aged 2 to < 60 months in an urban tertiary referral care centre the following emerged as significant factors for mortality . 1. Low birth weight between 2- 2.49 kg 2. Severe acute malnutrition 3. Children exposed to bad child rearing practices 4. Non breast fed status 5. Not immunized with measles vaccine 6. Hypoxemia at first contact with medical care Preferably such children should be admitted in pediatric intensive care unit for more aggressive monitoring and management that could reduce their mortality.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Predictors ; Mortality ; Hospitalized Children Aged 2 ; Less than 60 Months ; Very Severe Pneumonia ; Urban Tertiary ; Referral Health Care.
Subjects: MEDICAL > Paediatrics
Depositing User: Ravindran C
Date Deposited: 16 Apr 2018 05:20
Last Modified: 16 Apr 2018 11:27
URI: http://repository-tnmgrmu.ac.in/id/eprint/6999

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