Are grunting respirations a sign of serious bacterial infection in children?

Aim: To assess the significance of grunting respirations in children and their potential association with serious bacterial infections, and to identify characteristics unique to this patient group. Patients and Methods: A prospective case-control design was used. Data were collected on all children who were hospitalized with grunting respirations in our department of paediatrics over a 13-month period. The enrolled patients were divided into three groups: previously healthy children aged 3 months or less, previously healthy children aged more than 3 months and children with chronic illness at any age. The findings were compared to matched controls hospitalized for similar symptoms but without grunting respirations. Results: Grunting respirations were documented in 149 of the 3334 admissions (4.5%) during the period of study. The incidence was higher in children aged 3 months or less (7.5%) and lower in children older than 3 months (3.9%). Fever and respiratory symptoms were common (83.9% and 65.1%, respectively). Heart rate was the only vital sign that was significantly different between the study and control groups. Serious bacterial infection occurred more frequently in the study group (31.5% vs. 14.8%, p < 0.001, OR 2.14, 95% CI 1.36-3.36). Comparisons between the groups showed that grunting respirations were a sign of serious bacterial infection in previously healthy children older than 3 months (p = 0.007, OR 1.95, 95% CI 1.21-3.13) and in children with a chronic disease of any age (p = 0.033, OR 7.0, 95% CI 1.0-49.7 respectively), but not in previously healthy children younger than 3 months (p = 1).