Outcome of Community-Acquired Pneumonia in Children Admitted to PICU at Minia Children University Hospital.

Introduction
The term community-acquired pneumonia (CAP) refers to acute infection of lung parenchyma in a patient who gained the infection outside the hospital. CAP is a prevalent illness with high rates of morbidity that has the potential to be serious (1).

One of the main reasons of death and morbidity in children all over the world is pneumonia, accounting for a total number of 120 million new cases annually and the mortality rate among patients with severe pneumonia is approximately 8.7%, parti-cularly in young infants (2). 

Early CAP diagnosis and management is very important due to the high mortality rate of severe CAP in children (3).

Assessment of the disease's severity is a key component of the management of pediatric CAP, in many settings worldwide, this is primarily based on clinical symp-toms, signs, and radiological findings. 
A higher death rate is linked to improper outpatient care or delaying the admission of CAP patients to the pediatric intensive care unit (PICU) (4).
 
Aim of the work
To assess the clinical outcomes of community-acquired pneumonia (CAP) in children admitted to PICU at Maternity and Children's Hospital of Minia University in comparison with mild to moderate CAP pediatric patients admitted to the chest ward.

Methods:
Our prospective cross-sectional study was carried out at Maternity and Children's Hospital of Minia University, Pediatric Department (chest ward and pediatric ICU) during the period from June 2023 to December 2023 after obtaining an approval from Medical Ethical Committee, Faculty of Medicine, Minia University and written informed consents were obtained from the caregivers of included children. Eighty infants and children aging from 2 months to 5 years were enrolled in the study and they were grouped as following:
Group 1: 40 children with mild to moderate CAP admitted to chest ward as controls.  
Group 2: 40 children with severe CAP admitted to pediatric ICU (20 children on MV and 20 children not on MV) as cases.
The British Thoracic Society's classifi-cation system was used to determine the severity of CAP (5).

We excluded from our study patients with hospital acquired pneumonia, patients with congenital heart disease and congenital chest diseases, patients with other, patients with other infectious diseases as tuberculosis (TB), patients with bronchial asthma, diabetes, hepatitis and liver cell failure (LCF), also immunocompromised patients were excluded.
 
All studied children had been subjected to: 
•    Full history:  personal history, history of symptoms related to pneumonia and history of other medical illness and other infectious diseases.
•    Clinical examination: general exami-nation with vital signs assessment including blood pressure (BP), heart rate (HR), respiratory rate (RR), O2 saturation and temperature of the body. and local chest examination including chest inspection, palpation and auscultation.
•    Chest x- ray: postero-anterior views

Statistical analysis
SPSS 26 for windows (SPSS Inc., Chicago, IL, USA) was used to gather, tabulate, and statistically analyze all the data. 

To ascertain whether or not the data were normally distributed, the Shapiro Walk test was employed. Frequencies and relative percentages were utilized to express the qualitative data. The range and mean ± SD (standard deviation) was used to display the quantitative data.

To determine the difference between the qualitative variables, the Fisher Exact Test and the Chi Square Test were utilized. 

For parametric and non-parametric varia-bles, respectively, the difference between the quantitative variables in the two groups was determined by the Independent T test and the Mann Whitney test.

All statistical comparisons were two tailed with significance Level of P-value ≤ 0.05.
A P-value ≤ 0.05 indicates a significant difference, p<0.001 indicates a highly significant difference, and P>0.05 indicates a non-significant difference.
To determine the one-month mortality rate, logistic regression analysis was done.

Results
Clinical data of the studied groups were tabulated and statistically analyzed. Result of the study are shown in the present tables as following:    
The mean age of cases with mild to moderate pneumonia admitted to chest ward was 2.6 years compared to 2.5 years in cases with severe pneumonia admitted to PICU, also 52.5% of cases with mild to moderate pneumonia were males compared to 45% of cases with severe pneumonia, regarding the comparison of baseline data between cases with mild to moderate CAP and cases with severe CAP, the results was non-statistically significant (p value >0.05) (Table1).

Regarding the comparison of clinical data and radiological data between children with mild to moderate CAP and children  with severe CAP, the results was statistically significant regarding incidence of cyanosis, respiratory distress and complication (p value <0.05) the mean temperature of patients with mild to moderate pneumonia was 37.7 which is significantly lower than in cases with severe pneumonia (mean temperature=39.3), also lower percentage of cases with mild to moderate pneumonia had RD grade 4 and cyanosis (0% and 2.5%) than in cases with severe pneumonia (67.5% for each item separately). Also lower percentage of cases with mild to moderate pneumonia had multiple lobe lesions (20%) than in cases with severe pneumonia (90%), while a significant higher percentage of cases with mild to moderate pneumonia had no complication (82.5%) than in cases with severe pneumonia (42.5%)., as out of 40 cases with severe pneumonia, there were 9 cases had pleural effusion, 6 cases had hydropneumothorax, 5 cases had pneumothorax and 2 cases had septic shock, on other hand, non-significant difference was found regarding incidence of cough as all cases with CAP either mild or severe had cough (table2). Regarding the comparison of Duration of hospital and PICU stay, need for ventilation and 1 month mortality between cases with mild to moderate CAP and cases with severe CAP, the results were statistically significant (p value <0.05) as mean Duration of hospital and PICU stay was significantly lower among cases with mild to moderate CAP (7.7±2.8 days) than in cases with severe CAP (16.25±3.3 days).

Regarding mortality, it was found that 7 cases out of 40 cases with severe CAP died compared to only 1 case among cases with mild to moderate CAP (table 3).