Clinico-aetiological study of Pneumonia in two months to five years children admitted to district hospital

1. Synopsis Presentation
Guide Name Submitted By

2. Title of The Topics
Clinico-aetiological study of Pneumonia in two
months to five years children admitted to a
medical college in a district of West Bengal.

3. Introduction
 Pneumonia,defined as inflammation of the lung parenchyma ,is the leading
infectious cause of death globally among children younger than 5 year,accounting
for an estimated 9,20,000 deaths each year.1
 Pneumonia causes one-third of all under 5 deaths from infection(33%)2
 .Poverty plays an important role in pneumonia.Highest mortality rate due to
pneumonia is in poorly developed countries in Africa and South Asia.
 But deaths due to pneumonia in under 5 children gradually decreases due to
introduction of various vaccines like pneumococcal conjugate vaccines (PCV) and
effective antibiotics.
 Pneumonia may be classified anatomically as lobar or lobular
pneumonia,bronchopneumonia and interstitial pneumonia.Pathologically,there is
a consolidation of alveoli or infiltration of the interstitial tissue with inflammatory
cells or both

4. Etiology
Viral:
 RSV
 Influenza
 Para influenza
 Adenovirus
Bacterial:
o Pneumococci
o H.Influenzae
o Staphylococci
o Chlamydia
o Mycoplasma

5. Risk factor
 Low birth weight
 Malnutrion
 vitamin a defiency
 passive smoking
 large family size
 family history of bronchitis
 Crowding
 air pollution

6. Clinical features:
Onset of pneumonia may be insidious in onset with upper respiratory tract
infection or acute with high fever , tachypnea , dyspnea and grunting. Pneumonia
can be associated with flaring of alae nasi , retractions of lower chest and
intercostal spaces
According to the WHO.
Fever Tachypnea Chest indrawing Not able to drink
and/or central cyanosis
Stage I (non-severe) + +
Stage II (severe) + + +
Stage III (very severe) + + + +
Fever≥38°C (axillary ), Respiratory rate >50/min (2–11 months) and >40/min (1–5
years)

7. DANGER SIGNS:
 High Respiratory rate:
child age 2 months to 12 months-50 breaths per minute or more
12 months to 5 years- 40 breaths per minute or more
 Chest indrawing,
 Stridor,
 Wheezing.
 Lethargy,
 Central cyanosis.

8. Radiological investigation
All Children with pneumonia should preferably have a chest x-ray to identify the
underlying cause –
 Lobar consolidation: pneumococcal
 Pneumatocele:staphylococcal
 Diffuse interstitial and peribronchial involvement or effusion:streptococcal
 Poorly defined hazy or fluffy exudates radiate from hilar regions and pleural
effusion:primary atypical pneumonia

9. Objective of Research
Primary objectives
To study clinico-aetiological findings of cases admitted with children in
Pneumonia
Secondary objectives
 To evaluate the risk factors associated with Pneumonia in children
 To study the proportion of etiologies of Pneumonia in children

10. Review of Literature
There were several studies on Pneumonia in children
 Kamatham Madhusudhan,Bharathi Sreenivasaiah,Santhimayee Kalivela,Suresh Srinivasa
Nadavapalli,Ramesh Babu T conducted a study on “Clinical and bacterial profile of
pneumonia in 2 months to 5 years age children : a prospective study done in a tertiary care
hospital” and they concluded that lack of exclusive breast feeding till 6 months of
age,failure of complete immunization coverage,malnutrition are the risk factors for severe
pneumonia.8
 David M. Ie Roux and Healther J. Zar conducted a study on “Community-acquired
pneumonia in children –a changing spectrum of disease” and they conducted that much
progress has been made in decreasing deaths caused by childhood pneumonia.Improved
socioeconomic status and vaccinations, primarily the conjugate vaccines (against
Haemophilus influenzae and pneumococcus) have lead to reductions in the incidence and
severity of childhood pneumonia.

11.  Anna marie Nathan, Cindy Shuan Ju The, Kartini Abdul Jabar,Boon Teong
Teoh,Caroline Westerhout conducted a study on “Bacterial pneumonia and its
associated factors in children from a developing country : A prospective cohort
study “ and they concluded that bacteria remain an important cause of very severe
pneumonia in developing countries with one in four children admitted isolating
bacteria alone. Male gender and presence of crepitations were significantly
associated with bacterial aetiology.
 Klein J. Bacterial pneumonias. In: Feigin RD, Cherry JD et.al conducted a study on
“There is a spectrum of radiological appearances that are consistent with the
clinical and pathological diagnosis of pneumonia, ranging from complicated
pneumonia (e.g. pneumonia with empyema and necrotising pneumonia), simple or
uncomplicated pneumonia (e.g. lobar consolidation) to mild interstitial changes .
The characteristics of childhood pneumonia on CXRs generally assume a pattern
approach based on pathologic and radiologic characteristics”.
Review of Literature

12. Methodology
 Study Design: .Observational descriptive study.
 Study Setting and timelines:Children admitted with Pneumonia at Children
ward.Each Children will be followed up till discharge or final outcome.
 Place of Study:Malda Medical College and Hospital.
 Period of Study:1 year after getting ethical clearance (March 2021 to February
2022).
 Study Population:Two hundred fifty (250) Children admitted with Pneumonia
during study period in Malda Medical College and Hospital.
 Sample size: After considering previous 3 years, admission in children ward due to
pneumonia at Malda Medical College and Hospital,we can assume that 250
children can be studied over 1 year period.So, the sample size is taken as 250.

13. Methodology
Inclusion Criteria:
(1)Age two months to five years of both sex.
(2) admitted in children ward.
(3)Children with clinically & radiologically identified Pneumonia.
Exclusion Criteria:
1)Parents not willing to be enrolled in the study.
2)Patients with pre-existing heart disease.
Data collection:
After taking written informedconsent from the parents through face to face
interview,all relevant history will be obtained from the parents or other caregiver.Proper
clinical examination comprising of general survey,anthropometry and systemic
examination will be performed.Radiological and blood investigations will be sent.The
data will be captured in pre-structured proforma.All the study population will be
properly evaluated and treated for the present illness at the same time.

14. Reference
1)ROBERT M. KLIEGMAN, J. W. (2020). NELSON Textbook of Pediatrics,21st
edition,volume 1. Philadelphia: Elsevier.
2)WHO and Maternal and Child Epidemiology estimation Group estimates,2015 .
(n.d.).
3)Suresh Kumar Jakhar, M. P. (2018). Etiology and Risk factors Determining
Poor outcome of Severe Pneumonia in Under-Five Children. The Indian Journal
of Pediatrics, 20-24.
4) Gupta P, P. M. (2015). PG Textbook of Pediatrics Volume 1. New Delhi: Jaypee
Brothers Medical Publishers (P) Ltd.
5)Vinod K Paul, A. b. (2013). GHAI Essential Pediatrics. New Delhi: CBS
Publishers & Distributors.
6)R.Chaudhry, N. (1998). Prevalence of Mycoplasma pneumoniae and
Chlamydia pneumoniae in children with community acquired pneumonia. The
Indian Journal of Pediatrics, 717-721.

15. Reference
7) Manon Cevey-Macherel & Annick Galetto-Lacour ,Alain
Gervaix, Etiology of community-acquired pneumonia in
hospitalized children based on WHO clinical guidelines; Eur J
Pediatr (2009) 168:1429–1436
8)Kamatham Madhusudhan, B. S. (n.d.). Clinical and Bacterial
profile of Pneumonia in 2months to 5 years age children:a
prospective study done in a tertiary care hospital.
9)J.Zar, d. M. (n.d.). Community acquired pneumonia in children-
a changing spectrum of disease.
10)Anna Marie Nathan, C. S. (n.d.). Bacterial Pneumonia and its
associated factors in children from a developing country:a
prospective cohort study.

16. PATIENT PROFORMA
PATIENT PARTICULARS:
Serial no.:
Registration no.:
Name:
Age: Sex: Religion:
Address: Informant-mother/father/guardian:
Phone No.
HISTORY:
MOTHER,S INFORMATION:
Ante Natal History:
Birth history:
Immunisation History:
BABY,S INFORMATION:
CRIED IMMEDIATELY AFTER BIRTH: BIRTH WEIGHT:
GESTATIONAL AGE: MATURITY:PRETERM/ FULL TERM RESUSCITATION REQUIRED:
CLINICAL EXAMINATION:
GENERAL SURVEY:GENERAL CONDITION: ALERT/ LETHARGIC/ COMATOSE SPO2:
Heart Rate Respiratory Rate TemperatureApnea: Grunting: Chest Indrawing: Color: CRT>3 seconds : Cry: Tone: Convulsions:
Jaundice: Bleeding: Sucking: Skin pustule: No/ <10 / >10 Any associated Congenital Anomaly: Blood glucose:
ANTHROPOMETRY:
Length/Height: Head circumference:
Weight:
SYSTEMIC EXAMINATION:
RESPIRATORY:
CARDIOVASCULAR:
PER ABDOMEN:
CENTRAL NERVOUS SYSTEM:
OTHER SIGNIFICANT FINDING:
RADIOLOGICAL INVESTIGATION:
CHEST X-RAY FINDING:
USG Chest:
HRCT :
ECHOCARDIOGRAPHY,if required:
BLOOD INVESTIGATIONS:
Final diagnosis:
Outcome:Successfully discharged/Left against medical advice/death/referred.