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Risk of Hospitalization in Under-five Children With Community-Acquired Pneumonia: A Multicentric Prospective Cohort Study

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Abstract

Objective

To evaluate factors associated with risk of hospitalization in children with community-acquired pneumonia (CAP).

Design

Prospective cohort study.

Setting

Multi-site hospital based study.

Intervention

A separate acute respiratory tract infection (ARI) treatment unit (ATU) was established. The revised WHO case definition for ARI was used across all the study sites to ensure uniformity in management of ARI patients (2–59 months). Clinical history, examination findings and investigations of enrolled patients were recorded on a predesigned case record form. Children were followed up at 1 week (± 1 day).

Main outcome measure

Risk factors for hospitalization among pneumonia patients.

Results

A total of 7026 children with the diagnosis of ARI were enrolled. Pneumonia was diagnosed in 938 (13.4%) patients (median (IQR) age: 15 (8, 25) months; 63.5% boys). Hospitalization was needed in 56.8% of pneumonia patients. On multivariate analysis, factors associated with risk of hospitalization were: Oxygen saturation on pulse oximetry (SpO2) <92% in room air (OR 7.04; 95% CI 1.6, 30.8, >0.5 ng/mL (OR: 7.5, 95% CI: 1.0, 57.7, P=0.05), and lower weight for height z-score (OR 0.8; 95 % CI: 0.6, 0.9, P=0.02).

Conclusion

Present study found SpO2 <92% at room air, serum procalcitonin level >0.5 ng/mL and lower weight for height z-score to be predictors for risk of hospitalization in under-five children presenting with community acquired pneumonia. These factors can be utilized to assess a child with CAP regarding the need of hospitalization.

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Funding

Funding: This work was supported by Bill and Melinda Gates Foundation through the INCLEN Trust International (Grant number: OPP1084307). The funding source had no contribution in study design, implementation, collection and interpretation of data and report writing. Competing interest: None stated.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu & Kashmir, India

    Javeed Iqbal Bhat, Bashir A. Charoo & Ridwana Ahad

  2. Department of Pediatrics, Indian Council of Medical Research, New Delhi, India

    Aparna Mukherjee

  3. Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

    Rashmi R. Das, Partha Sarathi Ray & Samarendra Mahapatro

  4. Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

    Jagdish Prasad Goyal, Daisy Khera, Deepak Singhal, Kuldeep Singh & Prawin Kumar

  5. Department of Pediatrics, MP Saha Medical College, Jamnagar, Gujarat, India

    Bhadresh Vyas

  6. Department of Pediatrics, Karnataka Institute of Medical Sciences, Hubballi, Karnataka, India

    Vinod H. Ratageri

  7. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Rakesh Lodha, K. R. Jat & S. K. Kabra

Authors
  1. Javeed Iqbal Bhat
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  2. Bashir A. Charoo
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  3. Aparna Mukherjee
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  4. Ridwana Ahad
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  5. Rashmi R. Das
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  6. Jagdish Prasad Goyal
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  7. Bhadresh Vyas
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  8. Vinod H. Ratageri
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  9. Rakesh Lodha
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  10. Daisy Khera
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  11. Deepak Singhal
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  12. K. R. Jat
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  13. Kuldeep Singh
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  14. Partha Sarathi Ray
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  15. Prawin Kumar
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  16. Samarendra Mahapatro
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  17. S. K. Kabra
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Contributions

JIB, BAC, RA: involved in data collection and manuscript writing; AM,RL: involved in development of protocol, supervision of the study, data analysis; JPG, RRD, VHR, BV: data collection, manuscript review. All authors approved the final version submitted.

Corresponding author

Correspondence to Javeed Iqbal Bhat.

Additional information

Full list of ATU Group provided in Annexure I.

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Cite this article

Bhat, J.I., Charoo, B.A., Mukherjee, A. et al. Risk of Hospitalization in Under-five Children With Community-Acquired Pneumonia: A Multicentric Prospective Cohort Study. Indian Pediatr 58, 1019–1023 (2021). https://doi.org/10.1007/s13312-021-2366-4

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  • DOI: https://doi.org/10.1007/s13312-021-2366-4

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