Diagnosis and Assessment
Table 2. Criteria for Respiratory Distress Signs of Respiratory Distress in Children with Pneumonia ÎTachypnea, respiratory rate, breaths/mina
• 3-12 mo: > 50 • 1-5 y: > 40 • > 5 y: > 20
ÎDyspnea ÎRetractions (suprasternal, intercostals or subcostal) ÎGrunting ÎNasal flaring ÎApnea ÎAltered mental status
ÎPulse oximetry < 90% on room air a Adapted from World Health Organization (WHO) criteria.
Table 3. Criteria for CAP Severity of Illnessa
Clinician should consider care in an ICU or a unit with continuous cardiorespiratory monitoring for the child having ≥ 1 major, or ≥ 2 minor, criteria
ÎMajor criteria • Invasive mechanical ventilation • Fluid refractory shock • Acute need for NIPPVb • Hypoxia requiring FiO2
general care area ÎMinor criteria
• Respiratory rate > WHO classification for age • Apnea • Increased work of breathing (eg, retractions, dyspnea, nasal flaring, grunting) • PaO2
• Multilobar infiltrates • PEWS score > 6 • Altered mental status • Hypotension • Presence of effusion • Comorbid conditions (eg, HgbSS, immunosuppression, immunodeficiency) • Unexplained metabolic acidosis
/FiO2 < 250
a Modified from Table 4 in Mandell et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S38.
Abbreviations: FiO2, fraction of inspired oxygen; HgbSS, Hemoglobin SS disease; NIPPV, noninvasive positive pressure ventilation; PaO2 Warning Score
6 , arterial oxygen pressure; PEWS, Pediatric Early
greater than inspired concentration or flow feasible in
