Table 1 Case definitions of hospital-acquired pneumonia in children stratified by different age groups

Neonates

Onset >72 h after birth and one of the following radiologic criteria:

-new or progressive infiltrates

-consolidations

-adhesions or fluid in lobar fissures/pleura

And

Worsening gas exchange (SaO₂ ↓; O₂ requirement ↑; Ventilation parameters ↑)

And

Four of the following signs and symptoms:

-fever (>38.0°C), hypothermia (<36.5°C), or temperature instability

-new onset or increasing bradycardia (<80/min) or tachycardia (>200/min)

-new onset or increasing tachypnoea (>60/min) or apnoea (>20 seconds)

-new onset or increasing signs of dyspnoea (retractions, nasal flaring, grunting)

-increasing production of respiratory secretions and need for suctioning

-purulent tracheal secretion

-isolation of a pathogen in respiratory secretions

-elevated C-reactive protein (>20 mg/L)

I/T-ratio >0.2

Infants: 2–11 months

One of the following radiologic criteria:

-new or progressive infiltrate

-consolidations

-cavitations

-pneumatoceles

And

Worsening gas exchange (SaO₂ ↓; O₂ requirement ↑; Ventilation parameters ↑)

And

Three of the following signs and symptoms:

-fever (>38.0°C), hypothermia (<36.5°C), or temperature instability

-leucopenia (<4000 WBC/mm³) or leucocytosis (≥15,000 WBC/mm³) with left shift (≥10% band forms)

-new onset of purulent sputum, or change in character of sputum, or increased respiratory secretions, or increased suctioning requirements

-apnoea or dyspnoea (tachypnoea, nasal flaring, retraction of chest wall, grunting)

-wheezing, rales, or rhonchi

-cough

-bradycardia (<100/min) or tachycardia (>170/min)

Children: 1–16 years

One of the following radiologic criteria:

-new or progressive and persistent infiltrate

-consolidation

-cavitation

And

Three of the following signs and symptoms:

-fever (>38.4°C) or hypothermia (<36.5°C)

-leukopenia (<4000 WBC/mm³) or leucocytosis (≥15,000 WBC/mm³)

-new onset of purulent sputum or change in character of sputum or increased respiratory secretions or increased suctioning requirements

-new onset or worsening cough or dyspnoea, apnoea, or tachyponea

-rales or bronchial breath sounds

-worsening gas exchange (SaO₂ ↓; O₂ requirement ↑; Ventilation parameters ↑)