Analysis Of 901 Severe Community Acquired Pneumonia(CAP) Children From 2009 To 2014 In Suzhou

Objective To explore the clinical features and prognostic factors of severe community acquired pneumonia(CAP) in pediatric intensive care unit(PICU) of Suzhou area.Methods Data of clinical features, laboratory findings and outcomes from 901 children with severe CAP from Jan.1st 2009 to Dec. 30 th 2014 in PICU were retrospective collected..The data were analyzed by SPSS 17.0,measurement data were showed by x__±s, normal distribution and homogeneity of variance test were performed firstly, rate of two groups to were compared with x2 or Fisher ’s inspection, risk factors of mortalitywere performed by Logistic regression analysis. A value of P < 0.05 was considered statistically significant.Results(1)There were 901 inpatients diagnosed as severe CAP in PICU of the Children’s Hospital of Soochow University from Jan.1st 2009 to Dec. 30 th 2014. The male/female ratio was 1.32:1,the average age of onset was 6.47±3.74 months.Under 1 years of age accounted for 73.3%(660 cases). All cases received oxygen therapy,338 cases(37.5%)received mechanical ventilation(MV), 59 cases(6.5%) discharged voluntarily after giving up therapy, 33 cases(3.7%) died.(2) Co-morbid conditions : 244 cases(27.1%) of them had co-morbid conditions,33cases(3.7%) were diagnosed during PICU admission. Underlying congenital heart disease was most common(155/901, 17.2%), trisomy 21 accounted for 4.1%(37/901), cerebral palsy or other nervous system diseases accounted for 3.9%(35/901), preterm infants was 2.2%(20/901), malnutrition accounted for 1.8%(16/901).(3) CAP Pathogens: 334 cases in children with severe CAP were checked out 406 pathogens. The most common pathogens of children severe CAP were respiratory syncytial virus(RSV, 17.6%, 159/901) 、 mycoplasma pneumoniae,(8.9%,80/901) and influenza virus(6.0%, 54/901). The common bacteria pathogens were streptococcus pneumoniae(38 cases),haemophilus influenzae(28 cases), Staphylococcus aureus(16 cases) and moraxella catarrhalis(7 cases).(4) The possible risk factors of children with severe CAP prolonged ICU stay were: altered sensorium,PICU admission respiratory rate > 70 /min, head nodding, arterial oxygen saturation(Sa O2) < 80% and co-morbid(P﹤0.05).(5) The risk factors of children with severe CAP need MV were: age<12months, altered sensorium,PICU admission respiratory rate > 70 /min, groaning, head nodding, arterial oxygen saturation(Sa O2) < 80%, blood lactic acid >2.5mmol/L and co-morbid.(6) Age< 12 months, albumin <35g/L and co-morbid significantly correlated with mortality.Conclusions Young age and underlying disease were associated factors of severe CAP children in Suzhou. Early evaluation and management of co-morbid conditions and severity of CAP is beneficial to reduce the mortality of severe CAP, appropriate vaccination program should be established according to the local pathogen spectrum.