Related Experiment Videos
Clinical signs of pneumonia in infants under 2 months
S Singhi1, A Dhawan, S Kataria
1Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Clinical signs like rapid breathing and chest indrawing can predict pneumonia in infants. Adding nasal flaring improves diagnosis accuracy for infants under two months old.
Area of Science:
- Pediatrics
- Infectious Diseases
- Respiratory Medicine
Background:
- Pneumonia is a leading cause of death in infants globally.
- Accurate and timely diagnosis is crucial for effective treatment.
- Current diagnostic criteria, like World Health Organisation (WHO) entry criteria, may not capture all pneumonia cases in young infants.
Purpose of the Study:
- To identify clinical signs that accurately predict pneumonia in infants under two months of age.
- To evaluate the effectiveness of specific respiratory signs and additional clinical indicators for diagnosing infant pneumonia.
Main Methods:
- A comparative study involving 101 infants diagnosed with pneumonia and 150 with upper respiratory infections (URIs).
- Analysis of clinical signs including respiratory rate, chest indrawing, nasal flaring, feeding status, general appearance, temperature, and abdominal distension.
- Evaluation of diagnostic accuracy (sensitivity and specificity) of various sign combinations.
Main Results:
- Respiratory rate ≥ 60/min and/or severe chest indrawing showed 85% sensitivity and 97% specificity for pneumonia in infants meeting WHO criteria.
- Adding nasal flaring improved sensitivity by 6% without reducing specificity.
- Non-specific signs were critical for diagnosing pneumonia in five low-birth-weight infants (< 2500g).
Conclusions:
- A respiratory rate ≥ 60/min and/or chest indrawing are reliable indicators for identifying pneumonia in infants.
- Nasal flaring should be considered for addition to diagnostic criteria for infants under two months presenting with cough or difficult/rapid breathing.
- Specific clinical signs are vital for diagnosing pneumonia, especially in vulnerable low-birth-weight infants.
Abstract:
To determine clinical signs that can predict pneumonia (confirmed by radiography) in infants under 2 months of age, 101 infants with pneumonia and 150 with an upper respiratory infection (but not pneumonia) were studied. Ten infants with pneumonia and 15 with an upper respiratory infection did not have the cough and/or difficult (or rapid) breathing that are recommended as 'entry criteria' by the World Health Organisation (WHO). The remaining infants met WHO entry criteria; in them sensitivity and specificity of respiratory rate > or = 60/min and/or severe chest indrawing to diagnose pneumonia was 85% and 97% respectively. Addition of four non-specific signs (stopped feeding well, looked sick, temperature < or = 38 degrees C, and abdominal distension) to respiratory rate > or = 60/min and/or chest indrawing for case identification resulted in a 7% gain in sensitivity but 22% loss of specificity. Addition of nasal flaring improved the sensitivity by 6% without loss of specificity. However, the non-specific signs were the only clue to diagnosis in five infants weighing < or = 2500 g. At age < 7 days, a weight < or = 2500 g and cyanosis were associated with significantly higher risk of mortality. These findings support the use of a respiratory rate > or = 60/min and/or chest indrawing for identification of pneumonia, and suggest addition of nasal flaring to the criteria for case identification in infants under 2 months with cough and/or difficult or rapid breathing.