title: Predictors of duration and treatment failure of severe pneumonia in hospitalized young Nepalese children.
abstract: BACKGROUND
  Pneumonia in young children is still the most frequent cause of death in developing countries. We aimed to identify predictors for recovery and treatment failure in children hospitalized with severe pneumonia.
  
  
  METHODS
  We enrolled 610 Nepalese children, aged 2 - 35 months from February 2006 to June 2008. Study participants were provided with standard treatment for pneumonia and followed up until discharge. Three multiple regression models representing clinical variables, clinical and radiological combined and all variables, including C-reactive protein (CRP) and viral etiology were used to assess the associations.
  
  
  RESULTS
  The median age of study participants was 6 months with 493 (82%) infants and 367 (61%) males. The median time (IQR) till recovery was 49 (31, 87) hours and treatment failure was experienced by 209 (35%) of the children. Younger age, hypoxia on admission and radiographic pneumonia were independent predictors for both prolonged recovery and risk of treatment failure. While wasting and presence of any danger sign also predicted slower recovery, Parainfluenza type 1 isolated from the nasopharynx was associated with earlier resolution of illness. Gender, being breastfed, stunting, high fever, elevated CRP, presence of other viruses and supplementation with oral zinc did not show any significant association with these outcomes.
  
  
  CONCLUSIONS
  Age, hypoxia and consolidation on chest radiograph were significant predictors for time till recovery and treatment failure in children with severe pneumonia. While chest radiograph is not always needed, detection and treatment of hypoxia is a crucial step to guide the management of hospitalized children with pneumonia.
authors: Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal; Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway.
authors: Sudha
authors: S
authors: Basnet
authors: Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors: Arun
authors: A
authors: Sharma
authors: Department of Microbiology and Infection Control, University Hospital of North Norway, Tromso, Norway.
authors: Maria
authors: M
authors: Mathisen
authors: Child Health Department, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors: Prakash Sunder
authors: PS
authors: Shrestha
authors: Department of Radiology, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
authors: Ram Kumar
authors: RK
authors: Ghimire
authors: Department of Radiology, Kathmandu Medical College and Teaching Hospital, Kathmandu University, Nepal.
authors: Dhiraj Man
authors: DM
authors: Shrestha
authors: Department of Infectious Disease Epidemiology, Division of National Health Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark.
authors: Palle
authors: P
authors: Valentiner-Branth
authors: Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway; Department of International Public Health, the Norwegian Institute of Public Health, Oslo, Norway.
authors: Halvor
authors: H
authors: Sommerfelt
authors: Centre for International Health and Centre for Intervention Science in Maternal and Child health, University of Bergen, Bergen, Norway; Division of Medical Services, Innlandet Hospital Trust, Lillehammer, Norway.
authors: Tor A
authors: TA
authors: Strand
mesh_terms: D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011379:Prognosis; D012720:Severity of Illness Index; D017211:Treatment Failure; D016896:Treatment Outcome