Spooner et al identified risk factors in young children with pneumonia in Papua New Guinea. These can help identify a patient who may benefit from more aggressive management and closer monitoring. The authors are from the Institute of Medical Research in Goroka, Papua New Guinea.
Patient selection: < 5 years of age
Criteria for moderate pneumonia - all of the following:
(1) cough
(2) respiratory rate > 40 breaths per minute (WHO uses > 50 breaths per minute)
(3) chest indrawing
Criteria for severe pneumonia - moderate pneumonia with one of the following:
(1) cyanosis
(2) poor feeding
(3) heart failure (both pulse >= 160 beats per minute and hepatomegaly with liver palpable >= 2 cm below right costal margin)
Clinical features associated with increased risk of mortality (Table 2):
(1) cyanosis
(2) poor feeding
(3) bronchial breathing
(4) grunting
(5) nasal flaring
Other clinical features associated with severe pneumonia and increased mortality:
(1) first born child
(2) age < 12 months
(3) female gender
(4) malnourishment
(5) fever and other symptoms for > 7 days
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