Predictors of mortality in infants with sclerema presenting to the Centre for Diarrhoeal Disease, Dhaka

Risk Factors and Clinical Outcomes of Neonatal Sepsis in Manado Tertiary Referral Hospital: A Single-center Study

BACKGROUND: Neonatal sepsis remains a major cause of morbidity and mortality among newborn infants, both term and preterm. Even with effective treatment, the outcome is still uncertain, with inflated health-care cost due to prolonged length of stay in the Neonatal Intensive Care Unit. AIM: This study aimed to evaluate risk factors and their association with clinical outcomes of neonatal sepsis in a tertiary referral hospital in Manado, Indonesia. METHODS: This is a single-center retrospective cohort study of 365 neonatal sepsis subjects, conducted between January 2016 and December 2018. Risk factors were divided into two groups: Neonatal-related and maternal-related risk factors. Clinical outcomes analyzed were survival outcome (discharged or death) and hospital length of stay. Logistic regression, Mann–Whitney, and Kruskal–Wallis test were used in statistical analysis. RESULTS: From all risk factors, the highest mortality rate was found in neonates with sclerema (83.1%), and the lowest mortality rate in neonates without tachypnea (11.6%). Further multivariate statistical analysis revealed two risk factors associated with mortality, such as tachypnea (OR 4.94, 95% CI 2.257–10.841; p < 0.001) and sclerema (OR 34.47, 95% CI 15.135‒78.509; p < 0.001). Further analysis also reported several risk factors associated with prolonged length of stay, such as very low birth weight (p < 0.001), premature rupture of the membrane (p = 0.009), preterm gestational age (p < 0.001), and non-hospital delivery location (p = 0.013). CONCLUSION: In neonatal sepsis, the presence of tachypnea and sclerema was significant risk factors for mortality. Meanwhile, premature rupture of the membrane, very low birth weight, preterm gestational age, and non-hospital delivery location were risk factors associated with prolonged length of stay.

Clinical risk factors of death from pneumonia in children with severe acute malnutrition in an urban critical care ward of Bangladesh

Background

Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM.

Methods

For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105).

Results

The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension.

Conclusion and Significance

We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.

Clinical predictors and outcome of hypoxaemia among under-five diarrhoeal children with or without pneumonia in an urban hospital, Dhaka, Bangladesh

OBJECTIVE

To explore the predictors and outcome of hypoxaemia in children under 5 years of age who were hospitalized for the management of diarrhoea in Dhaka, where comorbidities are common.

METHODS

In a prospective cohort study, we enrolled all children <5 years of age admitted to the special care ward (SCW) of the Dhaka Hospital of ICDDR,B from September to December 2007. Those who presented with hypoxaemia (SpO(2) < 90%) constituted the study group, and those without hypoxaemia formed the comparison group.

RESULTS

A total of 258 children were enrolled, all had diarrhoea. Of the total, 198 (77%) had pneumonia and 106 (41%) had severe malnutrition (<-3 Z-score of weight for age of the median of the National Centre for Health Statistics), 119 (46%) had hypoxaemia and 138 children did not have hypoxaemia at the time of admission. Children with hypoxaemia had a higher probability of a fatal outcome (21%vs. 4%; P < 0.001). Using logistic regression analysis, the independent predictors of hypoxaemia at the time of presentation were lower chest wall indrawing [OR 6.91, 95% confidence intervals (CI) 3.66-13.08, P < 0.001], nasal flaring (OR 3.22, 95% CI 1.45-7.17, P = 0.004) and severe sepsis (OR 4.48, 95% CI 1.62-12.42, P = 0.004).

CONCLUSION

In this seriously ill population of children with diarrhoea and comorbidities, hypoxaemia was associated with high case-fatality rates. Independent clinical predictors of hypoxaemia in this population, identifiable at the time of admission, were lower chest wall indrawing, nasal flaring and the clinical syndrome of severe sepsis.