Pnömonisi Olan Çocuklarda Klinik, Laboratuvar Bulgular ve Prognostik Faktörler

Abstract

Our study was conducted to determine the risk factors, the clinical and laboratory findings, the prognostic factors and the effect of these conditions on the hospitalization cost in patients hospitalized for community-acquired pneumonia (CAP) and to contribute to the literature on this issue From May 1, 2019, to May 1, 2020, 170 patients, aged between 1 month and 18 years were hospitalized with diagnosis of CAP were included in our study. The mean age was 56.2 ± 51.9 months, the median was 38 months (1 month – 214 months). Fifty-two percent of the patients were girls and 48% were boys. Sixty-seven percent of the patients had at least one comorbidity; pneumonia was most commonly associated with chronic lung disease, neurological disease, and congenital heart disease. Cough, fever, wheezing, and respiratory distress were the most common admissions complaints. Physical examination findings of the patients on admission to the hospital were mostly retraction and tachypnea. In laboratory evaluation, neutrophilia, lymphopenia, anemia, leukocytosis, hypoalbuminemia, thrombocytosis, and thrombocytopenia were detected, respectively. During post-hospitalization follow-up, 131 patients (77%) needed oxygen (with mask or nasal cannula [n = 64], high flow oxygen therapy [HFOT] [n = 39], continuous positive airway pressure [CPAP] [n = 19], and mechanical ventilator [n = 19]). Respiratory viral panel (RVP) was taken from 109 patients, 55% of them had viral agents, blood culture was taken from 51 patients and the positivity rate was 1.9%. Severe pneumonia was present in 126 (73.5%) of the patients. Severe pneumonia and oxygen need were higher in those with viral agents in RVP. Complicated pneumonia was detected in 19 patients. Anemia, hypoalbuminemia had a significant relationship with severe pneumonia and complicated pneumonia. Severe pneumonia was less common in patients with lobar pneumonia on chest X-ray compared to multifocal and interstitial pneumonia. In multifocal pneumonia, complicated pneumonia and the need for mechanical ventilators were increased compared to other pneumonia (lobar and interstitial), and patients with multifocal pneumonia had persistent fever after hospitalization. Complicated pneumonia, anemia, thrombocytopenia, C-reactive protein (CRP), and hypoalbuminemia were significantly higher in patients whose fever lasted more than 2 days after hospitalization (n = 39). Fever lasting more than 3 days before admission to the hospital (n = 38) was found to be associated with only hypoalbuminemia (p = 0.005). In patients who used oral antibiotics in the last 5 days before hospitalization (n = 71), complicated pneumonia and fever lasting longer than 3 days prior to hospitalization were higher. It was found that the rate of severe pneumonia increased in patients with increased frequency of pneumonia or who need oxygen support at home, but did not increase in patients with tracheostomy. Ten percent of the patients had been re-hospitalized due to pneumonia in the last 30 days, 25.9% in the last 6 months and approximately one third of the patients had recurrent pneumonia. Although there was no relationship between comorbidity and severe pneumonia, recurrent pneumonia was more common in patients with comorbidity. In patients who received technological support (i.e., tracheostomy, gastrostomy, colostomy or ventriculoperitoneal [VP] shunt inserted), the rate of re-hospitalization in the last 30 days and 6 months was increased. Recurrent pneumonia was associated with swallowing dysfunction, chronic lung disease, mental motor retardation, neurological disease, prematurity, and neuromuscular disease, respectively. Mean time of hospitalization due to pneumonia was 9 days (3-56 days), which was longer in patient who received oxygen, had severe or complicated pneumonia and comorbidity. The mean cost of hospitalization for pneumonia was 1896 TL (Turkish Lira) (161-21.030 TL), which increased in comorbidity, complicated pneumonia and recurrent pneumonia. Keywords: Community-Acquired Pneumonia, Risk Factors, Clinical Findings, Laboratory Findings, Cost