From the Guidelines
Admission criteria for pediatric pneumonia include children with severe pneumonia characterized by respiratory distress, hypoxemia (oxygen saturation <92% on room air), or inability to maintain hydration 1.
Key Admission Criteria
- Children with pneumonia who require supplemental oxygen, intravenous antibiotics such as amoxicillin (90mg/kg/day divided every 8 hours) or ceftriaxone (50mg/kg/day divided every 12 hours), or have underlying medical conditions that compromise their immune system should be admitted for close monitoring and treatment 1.
- Children under 3 months of age with pneumonia or those with apnea, lethargy, or severe respiratory distress also meet admission criteria 1.
Additional Considerations
- Tachypnea, defined as a respiratory rate of >60 breaths/min for infants 0-2 months, >50 breaths/min for infants 2-12 months, >40 breaths/min for children 1-5 years, and >20 breaths/min for children >5 years, is a significant indicator of respiratory distress and potential need for hospitalization 1.
- Pulse oximetry measurement < 92% at room air is a strong indicator for hospital admission 1.
- Children with comorbid conditions, such as reactive airway disease, genetic syndromes, and neurocognitive disorders, are at higher risk of developing severe pneumonia and may require hospitalization 1.
From the Research
Admission Criteria for Pediatric Pneumonia
The admission criteria for pediatric pneumonia can be determined by various factors, including:
- Clinical factors such as age, oxygen saturation, age-based respiratory rate, and gestational age 2
- Radiographic findings, including moderate/large pleural effusions and multilobar infiltrates 3
- Laboratory findings, such as serum procalcitonin levels 3
- Severity of symptoms, including inability to drink/feed, vomiting, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% 3
Predictors of Severity
Some predictors of severity in pediatric pneumonia include:
- Hypoxemia (oxygen saturation ≤92%) 4, 3
- Age-specific tachypnea 4
- High temperature (≥38.5°C) 4
- Chest retraction score 4
- Multifocal radiographic changes 4
- Increased work of breathing 3
Hospitalization Indicators
Indicators for hospitalization in pediatric pneumonia include:
- Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% 3
- Moderate/large pleural effusions and multilobar infiltrates 3
- Need for supplemental oxygen or respiratory support 2
- Need for intravenous fluids or medications 2