AUTHOR=Shaima Shamsun Nahar , Alam Tahmina , Bin Shahid Abu Sadat Mohammad Sayeem , Shahrin Lubaba , Sarmin Monira , Afroze Farzana , Parvin Irin , Nuzhat Sharika , Jahan Yasmin , Mamun Gazi Md. Salahuddin , Saha Haimanti , Ackhter Mst. Mahmuda , Islam Md. Zahidul , Shahunja K. M. , Islam Sufia , Ahmed Tahmeed , Chisti Mohammod Jobayer 

TITLE=Prevalence, Predictive Factors, and Outcomes of Respiratory Failure in Children With Pneumonia Admitted in a Developing Country

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.841628

DOI=10.3389/fped.2022.841628

ISSN=2296-2360

ABSTRACT=Background 
Pneumonia has been the leading infectious cause of morbidity and mortality in children under five years of age for the last several decades. Although most of these deaths occur due to respiratory failure, published data are limited regarding predicting factors and outcomes of respiratory failure in children hospitalized with pneumonia or severe pneumonia.  

Objectives 
This study aimed to explore the prevalence, predicting factors, and outcomes of respiratory failure in children under five with pneumonia or severe pneumonia. 

Methods 
In this retrospective chart analysis, we enrolled children under five years of age hospitalized with pneumonia or severe pneumonia in Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between August 2013 and December 2017. Comparisons were made between children with respiratory failure (n=212) and those without respiratory failure (n=4412). Respiratory failure was defined when the SpO2/FiO2 was < 315. 

Results 
A total of 4625 children with pneumonia or severe pneumonia was admitted during the study period. Among them, 212 (4.6%) developed respiratory failure and formed the case group. 4412 (95.3%) children didn`t develop respiratory failure and formed the comparison group. In logistic regression analysis, after adjusting with potential confounders, severe sepsis (aOR: 12.68, 95% CI: 8.74-18.40), convulsion (aOR: 4.52, 95% CI:3.06-6.68), anemia (aOR: 1.76, 95% CI: 1.20-2.57) and severe underweight (aOR: 1.97, 95% CI: 1.34-2.89), were found to be independently associated with respiratory failure. As expected, children with respiratory failure more often had fatal outcome than without respiratory failure (74%, 1%, p<0.001). 
 
Conclusion 
The results of our analyses revealed that prevalence of respiratory failure was 4.6% among under-five children hospitalized for pneumonia or severe pneumonia. Severe sepsis, convulsion, anemia and severe underweight were the independent predictors for respiratory failure in such children and their case-fatality-rate was significantly higher than those without respiratory failure. Early recognition of these predicting factors of respiratory failure may help clinicians imitating prompt treatment that may further help to reduce deaths in such children, especially in resource-limited settings.