Journal of Global Pharma Technology

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CASE STUDY

A HOSPITAL BASED STUDY ON SOME CLINICO-

EPIDEMIOLOGICAL ASPECT OF BRONCHOPNEUMONIA AMONG
INFANTS AND YOUNG CHILDREN

Dhanapal C.K., Mathew J., Madhusudhan S., Manavalan R. and Roy V.*
Department of Pharmacy, Annamalai University, EHA, New Delhi.
*For Correspondence: E-mail: manivannan_biotech@yahoo.co.in

Abstract: A hospital based 6 months prospective study was carried out on children with clinical
diagnosis of bronchopneumonia in pediatric department of RMMC Chidambaram. The objective of the
study was to find out the proportional case rate and the clinico-epidemiological features of the disease.
The effectiveness of Nebulized salbutamol among bronchopneumonia children was also finding out. The
proportional case rate was found to be 2.24%. Low birth weight (18%) malnutrition (23%) no
immunization (17%), non-breast feeding (20%) and low socio-economic status (25%). Response to
nebulized salbutamol was remarkably higher (70%) in 6 to 12 month group.

Key words: Bronchopneumonia, Low Birth Weight, Malnutrition, Salbutamol, Socio-economic Status

INTRODUCTION hyperinflation, Wheeze and fine

Bronchopneumonia refers to inflammation
of the lung that is centered in the
bronchioles and leads to the production of
mucopurulent exudates that obstructs some
of the small airways and causes patchy
consolidation of the adjacent lobules.
Bronchopneumonia is usually a significant short term morbidity which
generalized process involving multiple
lobes of the lung. Acute respiratory
infections namely pneumonia cause up to
5 million deaths annually among children
less than 5 years old in developing nations
[1, 2, 3].
The estimated total of 12.9 million deaths
globally in 1990 in children under 5 years
of age, over 3.6 million were attributed to
acute respiratory infections mostly due to
pneumonia [4, 5]. This represents 28% of
all deaths in young children and places
pneumonia as the largest single cause of
childhood mortality. Bronchopneumonia is
the most important lower respiratory tract
illness of infant and children. It is an acute
viral syndrome characterized by
© 2009, JGPT. All Rights Reserved.
inspiratory crackles, mainly caused by
respiratory syncytial virus [6, 7, 8]. It is a
clinical continuum that incorporates viral
lower respiratory tract infection induced
airway hyperresonsiveness. It accounts for
about 8.5% of total respiratory diseases in
hospitalized children. It is associated with
needs hospitalization [9, 10, 11].
The incidence of bronchopneumonia
varies with several epidemiological factors
and with geographical areas [12, 13]. The
risk factors for developing pneumonia
include: (1) low weight for age, (2) Lack
of breast feeding, (3) Failure to complete
immunization, (4) Presence of coughing
sibling, (5) Poor environmental factors, (6)
Malnutrition and (7) Nasopharyngeal
colonization [14, 15]. There is a lack in
study in and around chidambarum. So in
this present scenario, a prospective study
was carried out with the objectives to find
out proportional case rate of
bronchopneumonia among infants and
young children, its clinico-epide-
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 Roy V. et al., Journal of Global Pharma Technology. 2009; 1(1): 107-112

epidemilogical features and effectiveness children for follow-up immediately if

of nebulised salbutamol.
MATERIALS AND METHODS
One year prospective study was
undertaken in the Department of Pediatric
Medicine, RMMC, Chidambaram. The
study was carried out from 1st November
2003 on children with clinical diagnosis of
bronchopneumonia in OPD and indoor
department. Clinical diagnosis criteria
were the first episode of acute respiratory
problems under 2 years of age with the
clinical evidence of hyperinflation,
wheeze, and fine in respiratory crackles.
Detailed history was taken regarding
complaints, birth weight including
prematuratity, history of exclusive breast
feeding and family history of allergy and
bronchial asthma [16, 17, 18, 19].
During physical examination emphasis
was given to respiratory rate heart rate,
respiratory distress, hyperinflation of chest
air entry, wheeze and crackles severity of
the disease was judged by respiratory rate,
chest retraction, head nodding and
cyanosis .Mild bronchopneumonia were
treated in out patients department. Mothers
are also advised to bring back their
anyone of following developed, viz.
breathing becomes difficult/breathing
becomes fast/feeding becomes a
problem/child becomes sicker [20, 21].
Children with moderate and severe
bronchopneumonia were admitted and
were clinically monitored for adequate air
entry, breathing and circulation. treatment
protocol for them were to keep on
humidified oxygen therapy for central
cyanosis/inability to drink /restlessness
severe lower chest wall in drawing
/grunting /respiratory rate more than 70
per minute. Breast feeding should be
continued as long as possible [22]. If
dehydration developed it should be treated
with usual line of treatment otherwise
children with severe bronchopneumonia
were treated with 2/3rd volume of normal
requirement maintenance fluid,
withholding oral feed. Once respiratory
distress settles, ryles tube/oral feeding
started gradually. Antibiotics were used in
critically sick children or with associated
secondary infection. Inhalation of
nebulised salbutamol was tried once and
continued only if there was evidence of
response to its initial administration [23,
24, 25].

RESULTS AND DISCUSSION bronchopneumonia was found highest in

the month of September and October.
Total 2854 children were treated from
pediatric department for different ailments Table 1 shows that, maximum
during the study period of 1 year. Out of preponderance of cases (34%) were below
them, 625 patients (2.24%) were 3 months of age with a slightly increased
diagnosed as bronchopneumonia. From it incidents in male sex. It may be probably
200 patients were selected for study being related to relatively smaller diameter
purpose. In this study the incidence of of airway tube.

Table 1: Age and sex wise distribution of bronchopneumonic patients.

Age No. of Cases Total
Male Female
Nos. % Nos. % Nos. %
< 3 month 68 34 16 8 32 16
3-1 month 29 14.5 25 12.5 49 24.5
Above 1 year 16 8 36 18 104 52

All age groups 123 61.5 77 38.5 200 100.00

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 Roy V. et al., Journal of Global Pharma Technology. 2009; 1(1): 107-112

Analysis of Table 2 shows that low socio-
economic status, mal-nutrition and non-
breast feeding were the contributory
factors for severe bronchopneumonia in
early age. Poor foetal nutrition leading to
mal-nutrition operated to increase the
severity of illness. Similarly non-
vaccination practices are also a risk factor
for severe bronchopneumonia in early age.
This might be explained by the production
of protective interferon produced by
administration of OPV which protect other
viruses also [26].

Table 2: Relation of some epidemiological factors with the severity of bronchopneumonia [n=200].
Risk Factors Cured Not Cured Dead Total
(n=156) (n=44) (n=12) (n=200)
Nos. % Nos. % Nos. % Nos. %
Not breast fed 33 21.15 7 15.90 - - 40 20

Low birth weight 30 19.23 6 13.63 - - 36 18

Mal-nutrition 38 24.35 8 18.18 - - 46 23

Low socio-economic status 39 25.00 11 25.00 - - 50 25

Not vaccinated 32 20.51 2 4.54 - - 34 17

Thus by reducing the incidents of From the analysis of Table 4, it was

premature, LBW babies preventing mal-
nutrition, promotion of exclusive breast
feeding and timely primary immunization
help to decrease the incidence of severe
acute lower respiratory tract infections
[27]. In relation of common clinical
features (Table 3) observed in children
suffering from bronchopneumonia it was
found that feeding problem tachycardia,
tachypnea, fever, cough and severe
respiratory distress were present
insignificantly higher proportion.
However, in relation to total
bronchopneumonia cases, cough was
present in 52.5%, respiratory distress in
0.5%, tachypnea in 8.5%, tachycardia in
10.5% and fever 56% cases.
Clinical symptomatology shows that fever,
cough, tachycardia, tachypnoea and severe
respiratory distress can be easily identified
by health care providers even without
instrumental aids [28, 29, 30].
observed that response to nebulization
found to be higher in age group of more
than 6 months (70%) whereas less
response was found to be higher (75% in
the age group of below 6 months). This
might be due to immaturity of bronchiolar
muscles, increased dynamic airway closure
and greater degree of mucosal oedema
with varying proportions. Good response
to salbutamol indicates that wheezing was
caused by bronchospasm and non-response
indicates that wheezing is caused by
mucosal oedema either or both situation
may exist in bronchopneumonia.
Nebulized salbutamol was tried on 78
children of bronchopneumonia. Among
them, 48 children were below 6 months
and rests were between 6 to 12 months
age. Responses were found only in 43%
case of below 6 months of age where as
response rate was remarkably higher
(70%) in the age group between 6 to 12
months.

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 Roy V. et al., Journal of Global Pharma Technology. 2009; 1(1): 107-112

Table 3: Common clinical features observed in bronchopneumonia [n=200].

Clinical Features Cured Not Cured Dead Total
(n=156) (n=44) (n=200)

Nos. % Nos. % Nos. % Nos. %

Without instrument
Fever 84 53.84 22 50.00 - - 106 53.0
Cough 75 48.07 26 59.09 - - 101 50.5
Tachycardia 6 3.84 7 15.90 - - 13 6.5
Tachypnea 8 5.12 6 13.63 - - 14 7.0
Severe Respiratory distress 2 1.28 1 2.27 - - 3 1.5

Without instrument - -
Wheeze 80 51.28 46 104.54 - - 126 63.0
Creptation 60 28.46 53 120.45 - - 113 56.50
Rales & Crackles 2 1.28 20 45.45 22 11.00

Table 4: Response of nebulization among infants suffering from bronchopneumonia.

Age Total Response by Nebulization
(In Months) (N=78)

<6 48 21 43.75
6-12 months 30 21 70.00
Above 12 months 78 42 53.85

(X2=4.9, D&F=1, P< 0.05 statistically significant)

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