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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Malawian children with chest-indrawing pneumonia with and without comorbidities or danger signs
Amy Sarah Ginsburg1, Tisungane Mvalo2, Melda Phiri2
1University of Washington, Seattle, Washington, USA.
Insights
Children with chest-indrawing pneumonia and comorbidities like HIV, malaria, or malnutrition had worse cure rates at Day 14. Intensive follow-up may benefit these vulnerable pediatric patients, even without danger signs.
Area of Science:
- Pediatric infectious diseases
- Clinical trial research
- Global health
Background:
- Children with comorbidities are often excluded from pneumonia treatment trials.
- This exclusion limits understanding of treatment efficacy in vulnerable populations.
Purpose of the Study:
- To compare cure rates in children with chest-indrawing pneumonia and comorbidities versus those without.
- To assess the impact of HIV, malaria, malnutrition, and anemia on pneumonia treatment outcomes.
Main Methods:
- Prospective observational cohort study of children with comorbidities.
- Concurrent prospective randomized controlled trial for comparison.
- Evaluated cure rates at Day 14 in Lilongwe, Malawi.
Main Results:
- Children with comorbidities (HIV, malaria, malnutrition) had higher rates of not being cured at Day 14.
- No significant difference in Day 6 treatment failure rates for comorbidities without danger signs.
- Significant cure failure rates at Day 14 for HIV-exposed/infected and malnourished children without danger signs.
Conclusions:
- Children with chest-indrawing pneumonia and comorbidities require careful monitoring.
- Intensive follow-up may improve outcomes for these children, even without initial danger signs.
Background:
Children with comorbidities or danger signs are often excluded from trials evaluating pneumonia treatment.
Methods:
We sought to investigate whether the percentage of children with chest-indrawing pneumonia cured at Day 14 was lower among those with HIV infection or exposure, malaria, moderate or severe acute malnutrition, or anemia enrolled in a prospective observational cohort study than among children without these comorbidities enrolled in a concurrent prospective randomized controlled trial evaluating duration of amoxicillin treatment in Lilongwe, Malawi.
Results:
Children with chest-indrawing pneumonia and comorbidities but without danger signs did not have statistically significant higher treatment failure rates by Day 6 than those in the chest-indrawing pneumonia clinical trial. However, children with chest-indrawing pneumonia and HIV infection or exposure, malaria, or moderate or severe acute malnutrition had higher rates of not being clinically cured at Day 14 when compared to children without these comorbidities (adjusted differences ranging from 7.7% to 17.0%). Furthermore, among children without danger signs at enrollment, but with HIV infection or HIV exposure or moderate or severe acute malnutrition, 12.5% and 15.6% respectively were not clinically cured at Day 14 even though they were without treatment failure by Day 6.
Conclusions:
More intensive follow-up of children with chest-indrawing pneumonia and comorbidities who do not have danger signs may be beneficial.
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