Estudio clínico y epidemiológico de la neumonía adquirida en la comunidad en niños menores de 5 años de edad

Abstract

Objective To describe the clinical characteristics of community-acquired pneumonia and associated morbidity in children under 5 years old. Patients and method We performed a prospective epidemiological study in 12 primary care clinics and two pediatric emergency departments in Vizcaya, Spain. Demographic, clinical, radiological, laboratory and treatment data were recorded at diagnosis. Different pneumonia groups were established on the basis of radiological images (lobar pattern), total leucocyte count (> 15.000/ml) and C-reactive protein value (> 80 mg/l). These groups ranged from definitive pneumococcal pneumonia (pneumococcus isolated in usually sterile specimens) to pneumonia of probable non-pneumococcal etiology. All patients were followed-up for 7 to 15 days after diagnosis to ascertain outcome. Results Between February and April 2003, 412 children with pneumonia were enrolled. The mean age was 33.4 ± 15.34 months and 21 % of the patients had received the pneumococcal conjugate vaccine. Overall 20 % had general malaise and 14.6% required admission, with a mean length of hospital stay of 4.10 ± 2.21 days. The mean length of treatment was 9.51 ± 2.44 days and the mean number of visits to the primary care pediatrician was 2.02 ± 1.10. Fifty-three patients (12.9 %) had definitive or highly probable pneumococcal pneumonia and these children had higher temperature (38.74 ± 0.84 vs 38.38 ± 0.94 °C), a higher percentage of general malaise (50.9 % vs 15.3%) and a higher hospitalization rate (41.5% vs 10.5 %). Conclusions Community-acquired pneumonia in children under 5 years old provokes high morbidity. According to clinical, radiological and laboratory data, suspected pneumococcal pneumonia seems more severe than forms probably caused by other agents.