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Clinical Rule Predicts Severe Illness in Infants

Algorithm could lower infant mortality in developing countries

FRIDAY, Jan. 11 (HealthDay News) -- A clinical algorithm consisting of seven signs and symptoms is useful for predicting severe illness in infants and could be used in developing countries to identify the infants who most need to be hospitalized, according to an article published in the Jan. 12 issue of The Lancet.

Martin Weber, M.D., of the World Health Organization Indonesia Country Office in Jakarta, along with The Young Infants Clinical Signs Study Group, recruited 8,889 infants under 2 months of age who presented with acute illness to health centers in Bangladesh, Bolivia, Ghana, India, Pakistan and South Africa, in order to investigate the diagnostic value of 31 symptoms and clinical signs in predicting severe illness (excluding jaundice).

In the first week of life, 12 symptoms or signs predicted severe illness, including poor feeding, convulsions, lethargy, tachypnea, grunting, severe chest indrawing, movement only when stimulated, fever, cyanosis, prolonged capillary refill and stiff limbs. A decision rule requiring one sign had a sensitivity of 87 percent and specificity of 74 percent in predicting severe illness. When the algorithm was reduced to the seven most prevalent signs, the diagnostic value was similar. The seven-sign algorithm also performed well in infants aged 1 week to 59 days (sensitivity 74 percent, specificity 79 percent).

"Applied widely, our algorithm should have a major effect on neonatal mortality, provided that families seek care for neonatal illness within the formal health sector," the authors conclude.

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