Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.

<h4>Background</h4>Child hospitalization for pneumonia remains common, and pneumonia is a major cause of child mortality. Early identification of clinical factors associated with serious outcomes may help target risk-mitigation strategies.<h4>Methods</h4>Pneumonia cases occur...

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Autores principales:	David M Le Roux, Mark P Nicol, Aneesa Vanker, Polite M Nduru, Heather J Zar
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/beaf24a86fe8471ebd29f2bfc007ef1f
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spelling	oai:doaj.org-article:beaf24a86fe8471ebd29f2bfc007ef1f2021-12-02T20:18:09ZFactors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.1932-620310.1371/journal.pone.0255790https://doaj.org/article/beaf24a86fe8471ebd29f2bfc007ef1f2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0255790https://doaj.org/toc/1932-6203<h4>Background</h4>Child hospitalization for pneumonia remains common, and pneumonia is a major cause of child mortality. Early identification of clinical factors associated with serious outcomes may help target risk-mitigation strategies.<h4>Methods</h4>Pneumonia cases occurring in the Drakenstein Child Health Study, a prospective birth cohort outside Cape Town, South Africa were analysed, and factors associated with serious outcomes of pneumonia were identified. Pregnant women were enrolled antenatally, followed through pregnancy, and mother-child pairs from birth to 2 years. Active surveillance for pneumonia was done. Children hospitalized with pneumonia had chest radiography and blood drawn for inflammatory markers; course, outcome and duration of hospitalization were investigated. Serious outcomes were defined as in-hospital mortality or admission to intensive care unit (ICU). Prolonged hospitalization was also explored as a proxy for severity. Features associated with serious outcomes or prolonged hospitalization were analysed using modified Poisson regression.<h4>Results</h4>Among 1143 live born infants, there were 174 hospitalized pneumonia events in 133 children under 2 years. Three children (1.7%) died, 14 (8%) required ICU admission for respiratory support. In modified Poisson regression, age < 2 months, preterm birth, or hypoxia (oxygen saturation <92%) were significantly associated with serious outcomes. Preterm birth, low birth weight, HIV exposure, stunting, or underweight-for-age (UWFA) were associated with prolonged hospitalization. Chest radiography, elevated C reactive protein, white blood cell and neutrophil counts were not useful to predict death or ICU admission in children hospitalized with pneumonia.<h4>Conclusions</h4>In this cohort, death from pneumonia was rare, but clinical features associated with serious outcomes and prolonged hospitalization were identified. These may help with risk stratification, to identify children who may benefit from enhanced monitoring or earlier escalation to respiratory support.David M Le RouxMark P NicolAneesa VankerPolite M NduruHeather J ZarPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 8, p e0255790 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q David M Le Roux Mark P Nicol Aneesa Vanker Polite M Nduru Heather J Zar Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.
description	<h4>Background</h4>Child hospitalization for pneumonia remains common, and pneumonia is a major cause of child mortality. Early identification of clinical factors associated with serious outcomes may help target risk-mitigation strategies.<h4>Methods</h4>Pneumonia cases occurring in the Drakenstein Child Health Study, a prospective birth cohort outside Cape Town, South Africa were analysed, and factors associated with serious outcomes of pneumonia were identified. Pregnant women were enrolled antenatally, followed through pregnancy, and mother-child pairs from birth to 2 years. Active surveillance for pneumonia was done. Children hospitalized with pneumonia had chest radiography and blood drawn for inflammatory markers; course, outcome and duration of hospitalization were investigated. Serious outcomes were defined as in-hospital mortality or admission to intensive care unit (ICU). Prolonged hospitalization was also explored as a proxy for severity. Features associated with serious outcomes or prolonged hospitalization were analysed using modified Poisson regression.<h4>Results</h4>Among 1143 live born infants, there were 174 hospitalized pneumonia events in 133 children under 2 years. Three children (1.7%) died, 14 (8%) required ICU admission for respiratory support. In modified Poisson regression, age < 2 months, preterm birth, or hypoxia (oxygen saturation <92%) were significantly associated with serious outcomes. Preterm birth, low birth weight, HIV exposure, stunting, or underweight-for-age (UWFA) were associated with prolonged hospitalization. Chest radiography, elevated C reactive protein, white blood cell and neutrophil counts were not useful to predict death or ICU admission in children hospitalized with pneumonia.<h4>Conclusions</h4>In this cohort, death from pneumonia was rare, but clinical features associated with serious outcomes and prolonged hospitalization were identified. These may help with risk stratification, to identify children who may benefit from enhanced monitoring or earlier escalation to respiratory support.
format	article
author	David M Le Roux Mark P Nicol Aneesa Vanker Polite M Nduru Heather J Zar
author_facet	David M Le Roux Mark P Nicol Aneesa Vanker Polite M Nduru Heather J Zar
author_sort	David M Le Roux
title	Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.
title_short	Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.
title_full	Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.
title_fullStr	Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.
title_full_unstemmed	Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.
title_sort	factors associated with serious outcomes of pneumonia among children in a birth cohort in south africa.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/beaf24a86fe8471ebd29f2bfc007ef1f
work_keys_str_mv	AT davidmleroux factorsassociatedwithseriousoutcomesofpneumoniaamongchildreninabirthcohortinsouthafrica AT markpnicol factorsassociatedwithseriousoutcomesofpneumoniaamongchildreninabirthcohortinsouthafrica AT aneesavanker factorsassociatedwithseriousoutcomesofpneumoniaamongchildreninabirthcohortinsouthafrica AT politemnduru factorsassociatedwithseriousoutcomesofpneumoniaamongchildreninabirthcohortinsouthafrica AT heatherjzar factorsassociatedwithseriousoutcomesofpneumoniaamongchildreninabirthcohortinsouthafrica
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Factors associated with serious outcomes of pneumonia among children in a birth cohort in South Africa.

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