Table 4.
Independent clinical predictors of severe illness in young infants*
| Bang et al11 | Duke et al†12 | English et al4 | English et al4 | Weber et al6 | YICSSG‡13 | ||
|---|---|---|---|---|---|---|---|
| 0–28 days | 0–59 days | 0–6 days | 7–59 days | 0–60 days | 0–6 days | ORs (range) | |
| Feeding | |||||||
| History of difficult feeding | – | – | 7.3 (3.1–16.8) | 2.8 (2.6–5.0) | >1.5 | 10.0 (6.9–14.5) | 1.5–10.0 |
| Reduced feeding ability | – | SP | – | – | >1.5 | – | 1.5–7.4 |
| Sucking weak, reduced or stopped | 7.9 (1.8–34.2) | – | – | – | – | – | 7.9 |
| Activity | |||||||
| History of change in level of activity | – | – | – | – | >1.5 | – | 1.5 |
| Lethargy | – | – | – | – | – | 3.5 (1.7–7.1) | 3.5 |
| Limps becoming limp | 3.3 (0.9–12.0) | – | – | – | – | – | 3.3 |
| Movement only when stimulated | – | – | – | – | – | 6.9 (3.0–15.5) | 6.9 |
| No spontaneous movement | – | – | – | – | >1.5 | – | 1.5 |
| Stiff limbs | – | – | – | – | – | 15.1 (2.2–105.9) | 15.1 |
| Respiratory | |||||||
| Apnea | – | 4.2 (1.1–15.4) | – | – | – | – | 4.2 |
| Cough | – | 0.1 (0.02–0.5) | – | 0.1 | |||
| Difficulty breathing | – | – | 2.1 (1.0–2.6) | 1.8 (0.9–3.5) | – | – | 1.8–2.1 |
| Fast breathing | – | – | – | 3.1 (1.8–5.3) | – | – | 3.1 |
| Grunting | – | – | – | – | >1.5 | 2.9 (1.1–7.5) | 1.5–2.9 |
| Severe (deep) lower chest indrawing | – | 3.6 (0.94–13.9) | 3.0 (1.1–8.2) | 2.4 (1.3–4.7) | >1.5 | 8.9 (4.0–20.1) | 1.5–8.9 |
| Respiratory rate ≥60 breaths per minute | – | – | – | – | >1.5 | 2.7 (1.9–3.8) | 1.5–2.7 |
| Skin | |||||||
| Cyanosis | – | – | – | 25.8 (1.9–354) | >1.5 | 13.7 (1.6–116.5) | 1.5–13.7 |
| Prolonged capillary refill | – | – | – | – | >1.5 | 10.5 (5.1–21.7) | 1.5–10.5 |
| ‘Skin cold’ (‘baby cold to touch’) | 3.5 (1.0–12.4) | 6.2 (1.5–26.6) | – | – | – | – | 3.5–6.2 |
| Temperature <35.5°C | – | – | – | – | – | 9.2 (4.6–18.6) | 9.2 |
| Temperature (axillary) ≥37.5°C | – | – | 3.2 (1.7–6.3) | – | >1.5 | 3.4 (2.4–4.9) | 1.5–3.4 |
| Conscious state | |||||||
| Conscious state agitated | – | – | – | – | >1.5 | – | 1.5 |
| Unconscious or drowsy | – | – | – | – | >1.5 | – | 1.5 |
| Others | |||||||
| Abnormal behaviour | – | – | 2.4 (1.2–4.6) | 3.1 (1.7–5.6) | – | – | 2.4–3.1 |
| Bulging fontanelle | – | – | – | 1.9 (3.0–39.9) | >1.5 | – | 1.5–1.9 |
| Cry abnormal, weak, or stopped | 14.3 (3.9–52.1) | – | – | – | – | – | 14.3 |
| History of convulsions | – | – | – | – | >1.5 | 15.4 (6.4–37.2) | 15.4 |
| Severe abdominal distension / vomiting | 6.8 (1.7–27.2) | – | – | – | – | – | 6.8 |
OR not reported; (p<0.001)
*
Values are multivariate ORs with 95% CIs
†
Studies reporting predictors (risk factors) for death
‡
Panel of best clinical predictors had comparable sensitivities and specificities in 0–6 days and 7–59 days age groups
SP, significant predictor; YICSSG, Young Infants Clinical Signs Study Group.