Clinical study of respiratory distress in admitted children with special reference to mortality

Respiratory Problems are common in infants and Children. Respiratory distress is an important cause of death in pediatric age group.

To know clinical profile and risk factors for mortality in children admitted with respiratory distress.

Prospective Study

March 2005 – April 2006

Children between Age of 1 month and 12 year presented with respiratory distress having no past history of respiratory distress.

200 admitted children were enrolled, detailed history taken, clinical examination done and recorded in preformed Performa. SpO2 was monitored constantly. Haemoglobin estimation and X-Ray chest of each child taken. All children were treated according to standard protocol. They were followed till discharge or death. The data analyzed to know socio-demographic variable, nutritional status, immunization status of children. Appropriate statistical tests were applied to study the significance of various risk factors and to know the predictors of mortality.

During the study period 1338 children were admitted and out of these, 14.9% (200/1338) had respiratory distress. Total deaths were 80/1338. Of this 46 patients were expired due to respiratory distress. Proportional Mortality rate 57.5% (46/80) Overall case fatality rate was 23% (46/200).

Case fatality rate in children : Below 2 months was 57.14% (8/14).

        Between 2 months to 59 months 21.53% (31/144)

        Above 60 months 16.67% (7/42)

Case fatality rate in Males : 24.7% (24/97)

        in Females : 21.3% (22/103)

Case fatality rate in children belonging to Urban Area :21.6 % (26/120)

Case fatality rate in children belonging to Rural Area :25 % (20/80)

Case fatality rate in children from low socio-economic status (Modified Prasad Classification III, IV, V) 23.% (42/180) and in children from high socio economic status (Modified Prasad Classification grade I, II) was 20% (4/20)

Case fatality rate in immunized children : was 18.7% (33/176) and in non immunized children was 54% (13/24)

Case fatality rate in under nourished children : (PEM Grade 1 to 4 according to IAP Classification was 26.% (23/88) and in children with normal nutritional status was 20.5% (23/112)

The Most common associated symptom in descending order were cough 78.26% (156/200), fever 74% (148/200), altered sensorium 34.50% (69/200), cyanosis 6.5% (13/200)

Most common sign was tachypnea 84% (168/200)

Case fatality rate in children with hypoxemia (SpO2 <90%) was 37% (33/89) and in patients with normal SpO2 (>90%) was 11.7% (13/111)

Case fatality rate in children having anemia (Hb <10 gm) was 29.25% (31/106) and in children with (Hb >10) was 15.96% (15/94)

Case fatality rate in children with abnormal radiological picture was 17.6 (21/119) and in children with normal radiological picture 18.5% (15/81)

Case fatality rate in children with primary respiratory cause of respiratory distress was 25% (12/72) and in children with non respiratory distress was 19.4% (14/72)

Case fatality rate due to respiratory distress in young infants <2 months was observed to be higher as compared to older children. (P Value <0.0005 significant).

The difference of case fatality rate due to respiratory distress observed in different gender, place of residence, socio-economic status were not significant.

Immunization was observed to be important determinant for protecting the child (P Value <0.0001, very highly significant).

Low SpO2 level was attributed to higher case fatality rate (P Value <0.0001, highly significant).

Case fatality rate due to respiratory distress was higher in children with anaemia and the difference was highly significant. (P Value < 0.025)

No significant difference was observed between mortality in children with abnormal and normal chest radiographs.

No significant difference was observed between mortality in children having respiratory distress due to primary respiratory cause and respiratory distress due to non respiratory cause.