85 Pneumonia in Children

Ambrose Agweyu 12/11/18

Where do kids die of pneumonia? : 98% in Low Income Countries

What is the mortality for inpatient kids with WHO classed severe pneumonia? : 15-25%

Why do kids die of pneumonia in the tropics? : Delayed Care Seeking, Lack of Good Inpatient Care, Ineffective Treatment (the drugs we’re giving might be wrong now, new bugs!) , Sub-optimal supportive care (lack of critical care)

What is the WHO strategy to reduce pneumonia burden in kids worldwide? : Protect: Breast Feeding, Vitamin A Supplementation (reduces mortality by 25% all cause), Prevent: Immunization (pneumococcal, haemophilus, diptheria, measles), Pollution, Treat: Case Management (IMCI - syndromic approach)

Severe Pneumonia Signs in Kids According to the WHO : Any one of these signs: Cyanosis, Grunting, Inability to drunk, Head Nodding, Decreased Consciousness, Hypoxia, Vomiting (maybe also mild pallor sugns of malnutrition)

What’s the problem with the WHO “Severe Pneumonia” Classification? : Super sensitive criteria, not particularly specific at all! (Could be malaria, TB, etc). Written back in 1990

Non Severe Pneumonia Signs According to the WHO : Lower chest wall indrawing, or fast breathing

Why do we need to split pneumonia into the WHO severe/non severe categories, what’s a particular concern with this classification? : Admit severe with IV abx. Send non severe home with oral abx. These guidelines are based on global outcomes, but African mortality is worse, so should we admit kids with indrawing in Africa? Generally don’t admit, but do reassess in 48 hours

What big study looked at causes of pneumonia in kids in 2018? : PERCH Trial (we think pneumococcal and haemophilus should be down as causes thanks to vaccines, but results not out yet)

What really suggests problem with WHO classification of non-severe pneumonia? (Outpatients, not severely ill, using just fast breathing, not indrawing as criteria) : Big trial in Pakistan in 2011 found no difference in outcomes when comparing amoxicillin and placebo!