Effects of Possible Risk Factors on Morbidity in Child Patients Hospitalized With Pneumonia

Öz

Objective: Childhood pneumonias are the most important mortality and morbidity reasons especially in developing countries. In this study, demographic attributes and important risk factors among children hospitalized with pneumonia were examined; their effects on complications and prognosis were evaluated.

Material and Methods: In this retrospective cross-sectional study, children diagnosed with pneumonia and hospitalized between January 2017- January 2018 in Pediatric Services and Intensive Care Unit (ICU) were evaluated. How factors such as demographic findings, nutrition (breast milk), presence of malnutrition, vaccination history, presence of chronic disease, crowded living conditions, passive smoking affected hospitalization and its duration; development of complications after the disease and survival findings were examined.

Results: Among 289 hospitalized patients, 53.3% were female, median age was 14 months and 65.4% of the patients were under 2 years old. Nineteen point seven percent of the patients had premature birth history, 76.1% of them had >2500 gr birth weight. It was determined from the postnatal histories that 15.9% of them required incubator care, 6.2% of them required mechanical ventilator. Among the patients, it was found out that 31.5% of the patients did not receive breast milk, 10% had malnutrition, 18% had incomplete vaccination, 26.6% were exposed to passive smoking, 37% had a chronic disease. The most common symptoms observed during the admission were cough (86.5%) and fever (60%), median symptom period was 3 days. The most common physical examination findings detected were tachypnea (68.9%) and retractions (60.9%). In their radiological evaluations, it is detected that 85.8% of the patients had pneumonic infiltration, 3,5% had lobar consolidation, 2.8% had pneumonic infiltration+pleural effusion, 2.1% had pneumonic infiltration+atelectasis, 1.1% had lober consolidation+pleural effusion and 0.3% had atelectasis. During their stay in the hospital, microorganisms could be detected in 9% of the culture samples taken from the patients. Fifty six point sevent percent of the patients received mono antibiotic therapy while the rest of them received combined antibiotic therapy. Median hospitalization period was 9 days (1-115 days) and 25.6% of the patients required ICU monitoring. Complication development rate of the patients in the course of pneumonia detected as 13.1%. Age, premature birth history, low birth weight, staying in the incubator or in mechanical ventilator during the postnatal period, presence of malnutrition, presence of chronic disease, tachypnea, retraction, fever, rale-ronchus parameters during physical examinations at the admission, presence of pneumonic infiltration or lobar consolidation with pleural effusion on the chest x-ray, were determined as the parameters affecting prolonged hospitalization, complication development in the follow-up and in ICU stay.

Conclusion: Being under 2 years of age, prematurity, low birth weight, absence of breast milk, incomplete vaccination and malnutrition are the significant risk factors for pneumonia dependent hospitalizations among children. Presence of additional neurological and genetic diseases and low oxygen saturation are identified as the factors impacting the need to stay in intensive care unit, length of stay and complications. Identifying and preventing the risk factors affecting course of the disease and the prognosis, its complications and hospitalization period will reduce the morbidity of the pneumonias in childhood.

Anahtar Kelimeler

• Pneumonia
• complication
• Risk factors

Pnömoni Tanısı İle Hastaneye Yatırılan Çocuk Hastalarda Olası Risk Faktörlerinin Morbidite Üzerine Etkileri

Öz

Amaç: Çocukluk çağı pnömonileri, özellikle gelişmekte olan ülkelerde en önemli mortalite ve morbidite nedenidir. Bu çalışmada pnömoni tanısı ile hastaneye yatışı yapılan çocukların demografik özellikleri ve pnömoni gelişiminde önemli risk faktörleri incelenmiş; komplikasyon gelişimi ve prognoz üzerine etkilerinin değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntemler: Bu tek merkezli retrospektif kesitsel çalışmada, Pediatri Servisleri ve Yoğun Bakım Ünitesi (YBÜ) ’ne Ocak 2017- Ocak 2018 tarihleri arasında pnömoni tanısı ile yatırılan hastalar değerlendirildi. Hastaların demografik bulguları, anne sütü alım öyküsü, malnütrisyon varlığı, aşılama durumu, kronik hastalık varlığı, kalabalık yaşam koşulları, pasif sigara içiciliği gibi faktörlerin hastane yatışını ve yatış süresini ne kadar etkilediği, hastalık sonrasında komplikasyon gelişme durumu ve sağkalım bulguları incelendi.

Bulgular: Pnömoni tanısı ile yatırılan 289 hastanın %53.3’ü kız olup ortanca yaşları 14 aydı ve hastaların %65.4’ü 2 yaşından küçüktü. Hastaların %19.7’sinde prematüre doğum öyküsü olup %76.1’i >2500 gr doğum ağırlığına sahipti; %15.9’unun postnatal dönemde küvöz bakımı, %6.2’sinin mekanik ventilatör ihtiyacı olmuştu. Hastaların %31.5’inin hiç anne sütü almadığı, %10’unun malnütre olduğu, %18’inin rutin aşılarının eksik olduğu, %26.6’sında pasif sigara maruziyeti, %37’sinde kronik hastalık varlığı saptandı. Başvuruda en sık gözlenen semptomlar öksürük (%86.5) ve ateş (%60) olup ortanca semptom süresi 3 gün idi. Başvuruda en sık saptanan fizik muayene bulguları ise takipne (%68.9) ve retraksiyonlar (%60.9)’di. Radyolojik incelemelerinde %85.8’inde pnömonik infiltrasyon, %3.5’inde lober konsolidasyon, %2.8’inde pnömonik infiltrasyon+plevral effüzyon, %2.1’inde pnömonik infiltrasyon+atelektazi, %1.1’inde lober konsolidasyon+plevral effüzyon ve %0.3’ünde atelektazi saptandı. Hastanede yatışları süresince hastalardan alınan kültürlerin %9’unda mikroorganizma üredi. Hastaların %56,7’si tekli antibiyotik tedavisi, diğerleri kombine antibiyotik tedavileri aldılar. Hastaneye yatış süresi ortanca 9 gün (1-115 gün) olup izlemde hastaların %25.6’sının yoğun bakım ünitesi izlemi gerekti. Pnömoni seyrinde komplikasyon gelişen hasta oranı %13.1 olarak saptandı. Yaş, prematüre doğum öyküsü, düşük doğum ağırlığı, postnatal dönemde küvözde veya mekanik ventilatörde kalma, malnütrisyon varlığı, kronik hastalık varlığı, başvuru muayenelerinde takipne, retraksiyon, ateş, ral-ronküs varlığı, akciğer grafisinde plevral effüzyonla birlikte pnömonik infiltrasyon veya lober konsolidasyon varlığı parametreleri uzamış hastane yatışında, pnömoni seyrinde komplikasyon gelişmesinde, YBÜ yatış gereksiniminde olası risk faktörleri olarak saptandı.

Sonuç: Küçük yaş, prematüre doğum öyküsü, düşük doğum ağırlığı, anne sütü almamak, eksik aşılanma ve malnütrisyon çocuklarda pnömoni nedenli hastaneye yatışlar için önemli risk faktörleridir. Yoğun bakım ünitesine yatış gereksinimini, yoğun bakım ünitesinde yatış süresini ve komplikasyon gelişimini etkileyen faktörler ise ek nörolojik ve genetik hastalıkların varlığı ve düşük oksijen saturasyonu olarak belirlenmiştir. Hastalığın seyrini ve prognozunu, komplikasyonlarını ve hastanın hastanede yatış süresini etkileyen olası risk faktörlerinin belirlenip önlenmesi çocukluk çağında pnömonilerin morbiditesini azaltacaktır. 

Anahtar Kelimeler

• Pnömoni
• komplikasyon
• Risk faktörleri

Kaynakça

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