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Ninety-four children consecutively admitted to the hospital between January 1980 and December 1982 with their first febrile convulsion (FC) were studied to assess the influence of the degree of pyrexia on the recurrence rate of FC. Thirty-eight of sixty-three children between 6 and 18 months of age (the peak incidence of FC) with fever above 40°C were almost seven times less likely to have subsequent convulsions with fever, than those whose initial febrile convulsion was associated with a lower degree of pyrexia. It is suggested that the degree of pyrexia is a factor that influences the recurrence of FC. This may explain why some children have a reduced frequency of subsequent FC compared with others who appear to be at comparable risk. [ABSTRACT FROM AUTHOR]

Objectives: We determined the pulse oximetry benefit in pediatric pneumonia mortality risk stratification and chest-indrawing pneumonia in-hospital mortality risk factors., Methods: We report the characteristics and in-hospital pneumonia-related mortality of children aged 2-59 months who were included in the Pneumonia Research Partnership to Assess WHO Recommendations dataset. We developed multivariable logistic regression models of chest-indrawing pneumonia to identify mortality risk factors., Results: Among 285,839 children, 164,244 (57.5%) from hospital-based studies were included. Pneumonia case fatality risk (CFR) without pulse oximetry measurement was higher than with measurement (5.8%, 95% confidence interval [CI] 5.6-5.9% vs 2.1%, 95% CI 1.9-2.4%). One in five children with chest-indrawing pneumonia was hypoxemic (19.7%, 95% CI 19.0-20.4%), and the hypoxemic CFR was 10.3% (95% CI 9.1-11.5%). Other mortality risk factors were younger age (either 2-5 months [adjusted odds ratio (aOR) 9.94, 95% CI 6.67-14.84] or 6-11 months [aOR 2.67, 95% CI 1.71-4.16]), moderate malnutrition (aOR 2.41, 95% CI 1.87-3.09), and female sex (aOR 1.82, 95% CI 1.43-2.32)., Conclusion: Children with a pulse oximetry measurement had a lower CFR. Many children hospitalized with chest-indrawing pneumonia were hypoxemic and one in 10 died. Young age and moderate malnutrition were risk factors for in-hospital chest-indrawing pneumonia-related mortality. Pulse oximetry should be integrated in pneumonia hospital care for children under 5 years., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The existing World Health Organization (WHO) pneumonia case management guidelines rely on clinical symptoms and signs for identifying, classifying, and treating pneumonia in children up to 5 years old. We aimed to collate an individual patient-level data set from large, high-quality pre-existing studies on pneumonia in children to identify a set of signs and symptoms with greater validity in the diagnosis, prognosis, and possible treatment of childhood pneumonia for the improvement of current pneumonia case management guidelines., Methods: Using data from a published systematic review and expert knowledge, we identified studies meeting our eligibility criteria and invited investigators to share individual-level patient data. We collected data on demographic information, general medical history, and current illness episode, including history, clinical presentation, chest radiograph findings when available, treatment, and outcome. Data were gathered separately from hospital-based and community-based cases. We performed a narrative synthesis to describe the final data set., Results: Forty-one separate data sets were included in the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) database, 26 of which were hospital-based and 15 were community-based. The PREPARE database includes 285 839 children with pneumonia (244 323 in the hospital and 41 516 in the community), with detailed descriptions of clinical presentation, clinical progression, and outcome. Of 9185 pneumonia-related deaths, 6836 (74%) occurred in children <1 year of age and 1317 (14%) in children aged 1-2 years. Of the 285 839 episodes, 280 998 occurred in children 0-59 months old, of which 129 584 (46%) were 2-11 months of age and 152 730 (54%) were males., Conclusions: This data set could identify an improved specific, sensitive set of criteria for diagnosing clinical pneumonia and help identify sick children in need of referral to a higher level of care or a change of therapy. Field studies could be designed based on insights from PREPARE analyses to validate a potential revised pneumonia algorithm. The PREPARE methodology can also act as a model for disease database assembly., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and declare the following activities and relationships: YBN is staff member of the World Health Organization., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

Introduction: Existing risk assessment tools to identify children at risk of hospitalised pneumonia-related mortality have shown suboptimal discriminatory value during external validation. Our objective was to derive and validate a novel risk assessment tool to identify children aged 2-59 months at risk of hospitalised pneumonia-related mortality across various settings., Methods: We used primary, baseline, patient-level data from 11 studies, including children evaluated for pneumonia in 20 low-income and middle-income countries. Patients with complete data were included in a logistic regression model to assess the association of candidate variables with the outcome hospitalised pneumonia-related mortality. Adjusted log coefficients were calculated for each candidate variable and assigned weighted points to derive the Pneumonia Research Partnership to Assess WHO Recommendations (PREPARE) risk assessment tool. We used bootstrapped selection with 200 repetitions to internally validate the PREPARE risk assessment tool., Results: A total of 27 388 children were included in the analysis (mean age 14.0 months, pneumonia-related case fatality ratio 3.1%). The PREPARE risk assessment tool included patient age, sex, weight-for-age z-score, body temperature, respiratory rate, unconsciousness or decreased level of consciousness, convulsions, cyanosis and hypoxaemia at baseline. The PREPARE risk assessment tool had good discriminatory value when internally validated (area under the curve 0.83, 95% CI 0.81 to 0.84)., Conclusions: The PREPARE risk assessment tool had good discriminatory ability for identifying children at risk of hospitalised pneumonia-related mortality in a large, geographically diverse dataset. After external validation, this tool may be implemented in various settings to identify children at risk of hospitalised pneumonia-related mortality., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Existing scores to identify children at risk of hospitalized pneumonia-related mortality lack broad external validation. Our objective was to externally validate three such risk scores., Methods: We applied the Respiratory Index of Severity in Children (RISC) for HIV-negative children, the RISC-Malawi, and the Pneumonia Etiology Research for Child Health (PERCH) scores to hospitalized children in the Pneumonia REsearch Partnerships to Assess WHO REcommendations (PREPARE) data set. The PREPARE data set includes pooled data from 41 studies on pediatric pneumonia from across the world. We calculated test characteristics and the area under the curve (AUC) for each of these clinical prediction rules., Results: The RISC score for HIV-negative children was applied to 3574 children 0-24 months and demonstrated poor discriminatory ability (AUC = 0.66, 95% confidence interval (CI) = 0.58-0.73) in the identification of children at risk of hospitalized pneumonia-related mortality. The RISC-Malawi score had fair discriminatory value (AUC = 0.75, 95% CI = 0.74-0.77) among 17 864 children 2-59 months. The PERCH score was applied to 732 children 1-59 months and also demonstrated poor discriminatory value (AUC = 0.55, 95% CI = 0.37-0.73)., Conclusions: In a large external application of the RISC, RISC-Malawi, and PERCH scores, a substantial number of children were misclassified for their risk of hospitalized pneumonia-related mortality. Although pneumonia risk scores have performed well among the cohorts in which they were derived, their performance diminished when externally applied. A generalizable risk assessment tool with higher sensitivity and specificity to identify children at risk of hospitalized pneumonia-related mortality may be needed. Such a generalizable risk assessment tool would need context-specific validation prior to implementation in that setting., Competing Interests: Competing interests: The authors have completed the ICMJE Declaration of Interest Form (available upon request from the corresponding author), and declare no conflicts of interest. YBN is staff member of the World Health Organization., (Copyright © 2021 by the Journal of Global Health. All rights reserved.)

Objective: Stunting affects 26.7% of children worldwide, and little is known about its effects on the outcomes of childhood pneumonia. We evaluated the effect of stunting on the outcomes of pneumonia among children enrolled in two large clinical trials., Methods: We analysed data from two WHO and USAID-sponsored inpatient treatment trials, the Severe Pneumonia Evaluation Antimicrobial Research study (n = 958) and the Amoxicillin Penicillin Pneumonia International Study (n = 1702), which enrolled children aged 2-59 months across 16 sites in LMICs. We assessed the effect of stunting (height-for-age Z score < -2) on treatment outcome and time to resolution of hypoxaemic pneumonia., Results: Among 2542 (96%) children with valid data for height, 28% were stunted and 12.8% failed treatment by 5 days. The failure rate among stunted patients was 16.0% vs. 11.5% among non-stunted patients [unadjusted RR = 1.24 (95% CI 1.08, 1.41); adjusted RR = 1.28 (95% CI 1.10, 1.48)]. An inverse relationship was observed between height and failure rates, even among non-stunted children. Among 845 patients with hypoxaemic pneumonia, stunting was associated with a lower probability of normalisation of respiratory rate [HR = 0.63 (95% CI 0.52, 0.75)] and oxygen saturation [HR = 0.74 (95% CI 0.61, 0.89)]., Conclusions: Stunting increases the risk of treatment failure and is associated with a longer course of recovery in children with pneumonia. Strategies to decrease stunting may decrease the burden of adverse outcomes in childhood pneumonia in low-resource settings., (© 2015 John Wiley & Sons Ltd.)

Haemophilus influenzae type b (Hib) vaccine was included in the Yemen immunization programme in 2005. This study compared the rates of very severe pneumonia and all-cause meningitis hospitalization and death, before and after introduction of conjugate Hib vaccine, and reports the results of the 2010 bacterial meningitis surveillance. A retrospective analysis was made of data collected for 2000-2010 for all children aged 2-60 months in the main children's hospital in Sana'a. Compared with the pre-Hib vaccination period, the post-Hib period showed significant and impressive reductions in the rates of hospitalization and death for all-cause meningitis. However, hospitalization and death for very severe pneumonia improved only modestly, and there was evidence of a decreasing but non-significant trend indicting that very severe pneumonia was a non-specific endpoint with multi-etiologies (both viral and bacterial). Very severe pneumonia remains the leading cause of severe morbidity and death for young children, particularly those aged < 12 months.

Background: Pneumonia is the leading cause of mortality in young children globally, and factors that affect tissue delivery of oxygen may affect outcomes of pneumonia. We studied whether altitude and anemia influence disease severity and outcomes in young children with World Health Organization-defined severe pneumonia., Methods: We analyzed data from the SPEAR (Severe Pneumonia Evaluation Antimicrobial Research) study, a World Health Organization- and USAID-sponsored multinational randomized controlled trial of antibiotics for severe pneumonia among children aged 2 to 59 months in resource-poor settings. The trial enrolled 958 children in 8 sites at varying elevations, classified as high (≥ 2000 m) or low (<2000 m) altitude. We compared illness severity and assessed the effect of anemia on treatment outcome at high and low altitudes, adjusting for potential confounders and study site., Results: Children at high altitudes had significantly lower oxygen saturation on presentation, more cyanosis, lower systolic blood pressure, and higher hemoglobin. After adjusting for potential confounders, anemia predicted treatment failure in children living at high altitude (relative risk: 4.07; 95% confidence interval: 2.60-6.38) but not at low altitude (relative risk: 1.12; 95% confidence interval: 0.96-1.30). Children at high altitude took longer to reach normoxemia than did children at lower altitudes (5.25 vs 0.75 days; P < .0001)., Conclusions: Children at high altitude present with more severe disease, and children with anemia at high altitude are at greater risk of poor outcome when being treated for severe pneumonia. Given the high global prevalence of anemia among young children, prevention and treatment of anemia should be a priority in children living at high altitude and could improve outcomes of pneumonia.

Background: Childhood acute bacterial meningitis (ABM) is an important cause of death and long-term neurological disability in Yemen, the only low income-high mortality country in the Arabian Peninsula. The objective of this study was to document the microbial characteristics, the antibacterial sensitivity pattern, and the outcome for children hospitalized with ABM, prior to the introduction of Haemophilus influenzae type b (Hib) vaccine in Yemen., Patients and Methods: The study was retrospective, conducted at a rural district hospital, serving the rural population of the northern parts of Yemen. All patients aged 1 month-15 years admitted between May 1999 and June 2001, with clinical evidence of meningitis and cerebrospinal fluid (CSF) cultured, were included in the study. Clinical information from case notes, including CSF result and the outcome on discharge, were obtained. Analysis of extracted data was performed using Epi Info software., Results: During the 2-year study period, 160 study patients met the inclusion criteria, and 7 (4.4%) were negative for bacterial growth. In the 153 positive cultures there were 46 (30.1%) Streptococcus pneumoniae (SP), 23 (15%) H. influenzae (HI), 81 (52.9) Neisseria meningitidis (NM), 2 (1.3%) Staphylococcus aureus (S. aureus), and 1 (0.7%) Escherichia coli. Sixteen study patients died (overall case fatality rate (CFR) 10%), 7 aged under 12 months, 6 aged 12-60 months, and 3 more than 60 months. Ten deaths were due to SP meningitis, 2 HI meningitis, 3 NM meningitis, and 1 had S. aureus. Of the 144 survivors, 28 (19.4%) developed permanent neurological complications, 17 aged less than 12 months, 6 aged 12-60 months, and 5 more than 60 months. SP meningitis accounted for 57.1% (16/28), and 6 (21.4%) had HI meningitis. Among the 89 aged 1-60 months, 13 died (CFR 14.6%), and 23 (30.3%) of the 76 survivors developed permanent complications. Of those tested 20% and 35% of the 20 HI tested isolates and 9.5% and 14.3% of the 42 SP isolates, were resistant to ampicillin and penicillin G, respectively, and the majority of the 81 NM isolates were sensitive to both. The 3 pathogens were largely resistant to gentamicin, and almost all were susceptible to chloramphenicol and cefotaxime., Conclusion: In contrast to the studies from the low-mortality countries of the region, our study showed that the predominant pathogens of childhood ABM were SP and NM. SP meningitis was associated with increased mortality and permanent disability.

We conducted a 12-year retrospective analysis of perinatal characteristics at Al-Sabeen Hospital, Sana'a. There were 62168 births, 2936 stillbirths and 5434 perinatal deaths. There were 14 576 (24.6%) preterm low-birth-weight (LBW) babies. Early neonatal death (ENND) rate was 42.2/1000 live births. Of the 10 546 neonates admitted to the special baby care unit (SBCU), 40.1% were preterm LBW and 2147 (20.4%) died (80.6% were preterm LBW). The last 4 years showed a 17.2% increase in stillbirths and a 40.5% reduction in ENND compared with the first 4 years. In the SBCU, reduction in ENND was > 70%. Respiratory distress accounted for 63.8% of deaths in the SBCU and birth asphyxia 15.0%. Our results reflect the poor antenatal and delivery care services in Yemen.

The effect of breastfeeding on serum electrolytes and case fatality was studied in a group of 430 children admitted with severe dehydrating diarrhoea. Hyponatraemia and hypokalaemia were significantly more prevalent in infants who were exclusively bottle-fed (37.3% and 46.3%) compared with exclusively breastfed (12.2% and 16.7%) and among bottle-fed weaning children (46.3% and 62.6%) compared with weaning children who continued to breastfeed (24.7% and 36.7%, respectively). Mortality was lower in exclusively breastfed children (4.4%) than in those receiving formula feeds (16.4%); it was also lower in weaning children who continued to receive breast-milk (6%) than in bottle-fed weaning children (13.8%). Breastfeeding significantly reduces case fatality and the likelihood of electrolyte disturbances among infants hospitalized with severe dehydrating diarrhoea.

A 1-year study of 529 Yemeni children under 5 years of age hospitalized for severe pneumonia was undertaken to define their clinical characteristics and to identify risk factors associated with death from pneumonia. There were 354 (66.9%) boys, 270 of the 529 (51%) were under 6 months of age and 457 (86.4%) were aged < or = 12 months. The clinical characteristics of the group were as follows. Boys constituted 70% of the group and under-1-year-olds 86%, weight-for-age was under 60% in 23%, clinical rickets was present in 50% and anaemia in 30% (30.1%). On admission, cyanosis was detected in 56%, heart failure in 21% and isolated hepatomegaly in 14%. Fifty-two children died (CFR 9.8%), of whom 25 (48%) were under 6 months of age and 20 (38.5%) were aged between 6 and 12 months. Only seven children aged over 1 year died from pneumonia. Weight-for-age less than 60%, rickets, haemoglobin < 10 g/dl, cyanosis and heart failure were associated with an increased risk of dying from severe pneumonia.