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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