Seizure ups risk of respiratory failure, death in children with pneumonia

Risk factors for seizure in children with pneumonia must be identified early for clinicians to treat them straightaway and potentially reduce deaths in these patients, particularly in resource-limited settings, suggests a recent study.

A retrospective chart analysis was conducted on children under 5 years of age with World Health Organization classified clinical (excluding seizure as one of the clinical diagnostics) and radiologic pneumonia, admitted to the intensive care unit at Dhaka Hospital of icddr,b in Bangladesh between August 2013 and December 2019.

The investigators initially identified the children with pneumonia who had seizure. For comparison, they randomly selected controls from the rest of the children with pneumonia who had no seizure. Prevalence and outcome of seizure patients were then measured. Finally, factors related to seizure in children with pneumonia compared with those without seizure were identified.

Seizure was characterized by sudden, violent, involuntary, and abnormal repetitive movements with or without loss or impairment of consciousness confirmed by an attending physician.

A total of 4,101 children with pneumonia were identified, of whom 514 (12.5 percent) had seizure. Compared with those without seizure, children having both pneumonia and seizure were more likely to develop respiratory failure (18 percent vs 3 percent; p<0.001) and die (13 percent vs 3 percent; p<0.001) during hospitalization.

Logistic regression analysis revealed that hypoxaemia (95 percent confidence interval [CI], 1.59–3.17; p<0.001), severe pneumonia (95 percent CI, 2.13–6.52; p<0.001), severe sepsis (95 percent CI, 1.30–2.88; p=0.001), and hypernatraemia (95 percent CI, 5.31–10.93; p<0.001) were independently associated with a higher risk of seizure.

In contrast, children with pneumonia having seizure were less likely to develop severe acute malnutrition (95 percent CI, 0.26–0.50; p<0.001).

“Pneumonia is the leading infectious cause of deaths in children under 5 for the last few decades,” the investigators said. “Development of seizure in those children is common and associated with increased risk of deaths.”