[A strategy for the management of hospitalized children with acute lower respiratory infections].
OBJECTIVE
To improve the quality of care provided to hospitalized children having acute lower respiratory infections (ALRI), to increase the knowledge on this health condition, and to broaden the utilization of health care resources through a program called "Winter Plan".


METHODS
The program comprised the use of guidelines for diagnosis and treatment, disease-oriented hospitalizations to provide an increased level of care, management of health care resources and implementation of computerized medical records. Systematic investigation of viral etiology was performed in order to rationalize the use of medications and reduce nosocomial infections.


RESULTS
During program implementation (19/V-19/IX/99), 3,317 children were admitted; 1,347 (40.61%) had ALRI, of which 1,096 (81%) were included in the study. Of them, 71% aged less than 1 year. Most ALRI were viral (68%). Admission criteria were: oxygen saturation <95%, tachypnea, retractions or pleural effusion (92.4% of the children). The demand magnitude prevented compliance with isolation guidelines in all cases. Treatment guidelines were followed in a high percentage of cases: 73% of children having bronchiolitis and 72% of those with viral pneumonia received no antibiotics and 96% of children with bacterial pneumonia were put on antibiotics as recommended; use of bronchodilators and corticosteroids was reduced. Medication costs were reduced especially in the corticosteroid group, which meant a greater impact on hospitalization costs.


CONCLUSIONS
To decrease ALRI morbidity and mortality there is a need to continue improving the quality of health care during hospitalization and to reinforce health promotion actions and preventive programs at the primary level.
Clínica Pediátrica, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
Ana M
AM
Ferrari
María C
MC
Pirez
Alicia
A
Ferreira
Ivonne
I
Rubio
Alicia
A
Montano
Rosa
R
Lojo
Graciela
G
Palomino
Gustavo
G
Giachetto
Alvaro
A
Galiana
María J
MJ
Sarachaga
Silvana
S
Mercado
Osvaldo
O
Martinez
Marta
M
Alberti
Hector
H
Chiparelli
Soledad
S
Mateos
Adriana
A
Varela
Daniela
D
Sandin
Cecilia
C
Montenegro
Gabriela
G
Algorta
María
M
Albini
D000208:Acute Disease; D000293:Adolescent; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D005260:Female; D006285:Health Planning; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D011787:Quality of Health Care; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000628:therapy; D012621:Seasons; D014583:Uruguay / Q000453:epidemiology