Recommendations for Pneumonia in Hospitalized Children With Neurologic Impairment

Abstract

Objectives: Children with neurologic impairment (CNI) are commonly hospitalized with pneumonia but are often excluded from practice guidelines. We sought to develop evidence-based, expert-panel endorsed recommendations for the care of CNI hospitalized with pneumonia.

Methods: We conducted an extensive literature search that formed the basis of drafted candidate recommendations for diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria. We convened a national panel of individuals with expertise in nursing, pediatric medicine (infectious diseases, pulmonology, hospital medicine, complex care), and family advocacy. Using the RAND/University of California Los Angeles Appropriateness Method, including a moderated panel meeting, panelists rated recommendations for appropriateness in 2 sequential rounds.

Results: The panel assessed 73 drafted recommendations for diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria for CNI hospitalized with pneumonia. After modifications to 2 of the drafted recommendations, the panel reached agreement on the appropriateness of 72 recommendations. Recommendations include management that minimizes the use of broad-spectrum antibiotics. Recommendations further emphasize collaboration with respiratory therapists for airway clearance and with families, outpatient managing physicians, and homecare providers for discharge. The recommendations for pneumonia diagnosis and management account for heterogeneity in the patient population, including comorbidities and risk factors (eg, aspiration risk), as well as severity of presenting illness.

Conclusion: Recommendations for appropriate diagnostic testing, antimicrobial treatment, airway clearance, and discharge criteria for CNI hospitalized with pneumonia can be used to inform clinical care. The effect of these recommendations on patient- and family-centered outcomes should be studied.