| Objective: Through retrospective data analysis,we try to further understand the epidemiological characteristics, clinical manifestations, etiology, treatment and prognostic factors of children with severe pneumonia. Furthermore, the feasibility of the current guidelines of diagnosis and treatment in children with severe pneumonia was evaluated.Methods: The study objects were the hospitalization patients (Age between≥28 days old and≤5 years old) who were diagnosed severe pneumonia from 1 January, 2005 to 30 April, 2008 of the Children's Hospital of Chongqing Medical University. This study used retrospective case study to understand the epidemiology, risk factors, clinical manifestations, etiology and treatment of children with severe pneumonia. And we also used COX-risk model to analyze the prognostic factors.Results: (1) In 349 cases of severe pneumonia, the ratio of male and female was 2.14: 1, and the ratio of urban and rural areas was 1:2.8. Less than 3 months infants were more susceptible to severe pneumonia. 67.2% severe pneumonia occurred in the spring and winter. (2) 58.5% of the children with severe pneumonia had high risk factors. The most common risk factors were congenital heart disease, premature babies & low birth weight infants and anemia. (3) In all cases, the range of the hospitalities was from 6 to 46 days. Average hospitalization time was 12.4±8.0 days, significantly longer than the hospitalization of mild pneumonia. The clinical features as follows:71.6% of children with fever, in which 44.4% of children with the temperature higher than 38.5℃; Most children had cough, breathlessness, cyanosis and dyspnea, accounting for 97.7%, 99.4%,99.14% and 37.8% respectively. Besides this, the performances of other systems were convulsions, disturbance of consciousness, hematemesis and hematochezia. (4) The most common virus of severe pneumonia was RSV and ADV. The most common bacteria isolated from sputum culture were Escherichia Coli, Klebsiella pneumoniae, and Haemophilus parainfluenzae. The virus infection did not increase the infection rates of bacteria. (5) The complications of severe pneumonia such as emphysema, pleural effusion, pneumothorax were less than before. But the acute lung injury and acute respiratory distress syndrome (ALT \ ARDS) became more important than before. (6) On the base of active anti-infective treatment, short-term and intravenous use of glucocorticoid could improve the prognosis. (7) The mortality of severe pneumonia was 2.87%. Using COX derived risk model, we had the following conclusions: the high-risk factors (risk factors: no risk factors for success treatment 0.762 [95% CI 0.662-0.877]) and complications (complications: without complications for successful treatment 0.603 [0.470-0.774]) were risk factors for poor prognosis. Age, gender and home environment had no significant difference for poor prognosis.Conclusions: In this study, Children with severe pneumonia in our hospital were mostly in line with the diagnostic criteria for severe pneumonia by Pediatric Branch of Chinese Medical Association respiratory Section. Less than three months infants were more susceptible to severe pneumonia, but not everyone reached the respiratory rate≥70/min. The majority of children had fever, but only 44.4% of children with the temperature reached the diagnostic criteria. In guidelines for the diagnosis of severe pneumonia, we should not focus on the respiratory rates and body temperature one-sidedly, but should add to high-risk factors and complications in a comprehensive assessment. If not, the possibility of misdiagnosis would increase, and the prognosis of these children would be harmed. |
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