Analysis Of Risk Factors Of Severe Pneumonia In Children In Northwest Yunnan Plateau Areas

ObjectiveSevere pneumonia in children is the leading cause of death in children under 5 years of age worldwide.To explore the risk factors for severe pneumonia and its poor prognosis in plateau areas,in order to help identify and judge high-risk children with severe pneumonia early in clinical work,provide evidence and reference for timely treatment in clinical work,and reduce the incidence and mortality of sequelae of severe pneumonia in children.MethodsThe case group consisted of 230 patients who met the diagnostic criteria for severe pneumonia admitted to the Department of Pediatrics of the First Affiliated Hospital of Dali University from January 2020 to December 2022 as the observation group,and were randomly selected.222 hospitalized children with mild pneumonia during the same period served as the control group.The gender,age,living environment(rural and urban),family population,birth status(gestational age,birth weight,history of asphyxia,etc.),white blood cell count,C-reactive protein,oxygenation index,procalcitonin,and pathogen physical examination of the two groups of children were statistically analyzed.Single factor analysis and multiple factor regression analysis were conducted using SPSS28.0 statistical software.Results1.General condition and comparison between the two groups:The male to female ratio of children in the observation group was 1.25:1,and the prevalence rate of men was slightly higher than that of women;The ratio of children in the observation group from rural areas to urban areas was 1.87:1,and the prevalence rate in rural areas was significantly higher than that in urban areas;The observation group had the highest prevalence rate of 29 days≤age<3 years old,accounting for 69.57%(160/230),while the control group had a statistically significant difference in the prevalence rate of children of the same age group,accounting for 52.25%(116/222)(P<0.05);The proportion of children with altitude above 2000m in the observation group was 70,43%(162/230)higher than that in the control group(59.90%(133/222),with a statistically significant difference(P<0.05);The proportion of children under term in the observation group was 15.65%(36/230)higher than that in the control group(2.25%(5/222)),with a statistically significant difference(P<0.05);The highest proportion of low birth weight infants in the observation group was 22,61%(52/230),while the control group accounted for 6.31%(14/222),with a statistically significant difference(P<0,05);There were 11 cases(4,78%)with a history of birth asphyxia in the observation group and 1 case(0.45%)in the control group,with a statistically significant difference(P<0.05);The positive detection rate of pathogens in the observation group was 54,78%(126/230),while the detection rate in the control group was 35,14%(78/222),with a statistically significant difference(P<0,05);There was no significant difference in prevalence among groups in terms of gender,ethnicity,family population,and living environment(P>0.05).Comparative analysis of the detection of major pathogens between the two groups:The detection rates of Streptococcus pneumoniae+rhinovirus in the observation group and the control group were 3.04%(7/230)and 0%(0/230),respectively,with a statistically significant difference between the groups(p<0.05);The detection rates of Mycoplasma pneumoniae in the two groups were 21.30%(49/230)and 6.76%(15/222),respectively,with a statistically significant difference between the two groups(p<0.05);The detection rates of Haemophilus influenzae in the two groups were 7.83%(18/230)and 4,95%(11/222),respectively,with no significant difference between the groups(p>0.05);The detection rates of Streptococcus pneumoniae between the two groups were 18.70%(43/230)and 14.86%(33/230),respectively,with no significant difference between the groups(p>0 05).3.In the 230 observation group,9 cases had a poor prognosis.The proportion of children with oxygenation index<300 and procalcitonin>2 ug/L in the poor prognosis group was significantly higher than that in the good prognosis group,with a statistically significant difference(P<0.05).No differences were found between the children with good prognosis and those with poor prognosis in gender,age,ethnicity,altitude,living environment,gestational age,birth asphyxia,family size,pathogen detection,C-reactive protein,white blood cell count,and birth weight(P>0.05).Oxygenation index<300(OR;12.052,95%CI:2.740～53.007)is an independent risk factor for poor prognosis in children in the observation group.Conclusions1.Infants,premature infants,history of birth asphyxia,low birth weight infants,and positive pathogen testing are independent risk factors for severe pneumonia in children at high altitude.2.The higher the altitude,the greater the possibility of severe pneumonia prevalence;In severe pneumonia,the positive rate of detection of Streptococcus pneumoniae combined with rhinovirus and Mycoplasma pneumoniae is higher.3.The decrease of oxygenation index and the increase of Calcitonin suggest that children with severe pneumonia may have poor prognosis.