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The presence of clinical signs in malnourished infants with acute lower respiratory tract infections.

OBJECTIVES
To determine the reliability of respiratory rate and subcostal retractions in diagnosing acute lower respiratory tract infection in malnourished children.


METHODS
One hundred forty-three children with acute lower respiratory tract infection were classified according to the Gomez classification as normal, mildly, moderately or severely malnourished. The presence of tachypnea, subcostal retractions and the sensitivity of either sign in identifying children with a clinical and radiological diagnosis of acute lower respiratory tract infection in each of the nutritional categories were evaluated and compared.


RESULTS
According to the Gomez classification, 21 (15%) of 143 subjects were severely malnourished, 40 (28%) were moderately malnourished, 38 (26%) were mildly malnourished and 44 (31%) were well nourished. The mean respiratory rates in subjects with normal nutrition and in mildly, moderately and severely malnourished subjects were 62.6+/-9.38 breaths/min, 61.3+/-5.57 breaths/min, 57.6+/-11.65 breaths/min and 49.9+/-9.04 breaths/min, respectively. The mean respiratory rate of those with normal nutrition was not significantly different from that of those with mild malnutrition (P>0.05), but there was a statistically significant difference between the normal subjects and both the moderately malnourished (P=0.03) and severely malnourished (P<0.001) subjects. Subcostal retraction was observed in 78% of total children, which represents 41 (93%) subjects with normal nutrition, 34 (89%) mildly malnourished subjects, 30 (75%) moderately malnourished subjects and 10 (47%) severely malnourished subjects. There was no statistically significant difference between the frequencies of subcostal retractions observed in children with normal nutrition and mildly malnourished children (P>0.05), but subcostal retraction frequencies were significantly lower both in moderately (P=0.03) and severely (P<0.001) malnourished children. Tachypnea frequency was also found to be significantly lower in moderately (P=0.04) and severely (P=0.03) malnourished children compared with the normal group. As a consequence, the sensitivity of the presence of both of these signs was found to be lower in these two groups. The coexistence rates of both findings were 95% for the patients with normal nutrition and 47% for the severely malnourished patients.


CONCLUSIONS
The current World Health Organization algorithm must be supported with other signs for the diagnosis of acute lower respiratory tract infection, especially in severely mal-nourished children.