Afebrile pneumonitis in infants: predictors of outcome

This study was performed to determine which elements of the history, physical examination, and laboratory data of infants with afebrile pneumonitis predict the need for hospitalization. We used a risk score based on clinical history and a respiratory score based on the respiratory physical examination, to assess 101 infants with afebrile pneumonitis in the emergency department. Admission and length of hospitalization were decided independently of the study. The population was divided into three groups depending on outcome: mild disease--outpatient management or hospitalization for up to 48 hours; moderate disease--three or more days of hospitalization; and severe disease--admission to the intensive care unit. Twenty-four infants were followed as outpatients. Seventy-seven children were hospitalized: 12 for 48 hours, and 61 for a mean of 4.5 days. Four children were admitted to the intensive care unit. Patients in group 2 versus group 1 were significantly younger and sicker on initial examination, as evidenced by a worse average respiratory score, general appearance, and severity of retractions. Other parameters, including risk score, did not predict course of illness as measured by length of hospitalization. Respiratory physical examination, especially general appearance and severity of retractions, and young age are associated with a worse outcome in afebrile pneumonitis.