{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:51:05Z","timestamp":1787028665484,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Respiratory support requirement among children hospitalized with pneumonia is a key marker of disease severity and resource needs, yet scalable risk stratification tools for routine hospital settings in Southern Vietnam remain limited. Background: This study aimed to develop and evaluate clinical and laboratory-based multivariable models to predict respiratory support requirement in children under five hospitalized with pneumonia, using a routine care dataset. Methods: We conducted a retrospective cohort study conducted at a tertiary pediatric hospital in Southern Vietnam (July 2024\u2013November 2025), children aged 2\u201359 months hospitalized with pneumonia were included after predefined exclusions. The outcome was the maximum (worst) level of respiratory support required during hospitalization (oxygen therapy, CPAP, or invasive mechanical ventilation), analyzed as a binary endpoint (any support vs. none) for model development. Candidate predictors included bedside clinical variables (age &lt; 12 months, malnutrition, recurrent pneumonia, cyanosis, tachypnea, chest indrawing) and complete blood count-derived inflammatory indices. Univariable logistic regression was used for crude associations. Two multivariable logistic regression models were built: Model 1 (clinical-only) and Model 2 (clinical + neutrophil-to-lymphocyte ratio [NLR]; primary). Discrimination was assessed using area under the ROC curve (AUC), and calibration was evaluated using the Hosmer\u2013Lemeshow test and observed-to-expected (O:E) ratio. Results: A total of 1797 children were included; 154 (8.6%) required respiratory support. In the primary model, independent predictors were age &lt; 12 months (aOR 2.57, 95% CI 1.69\u20133.92), malnutrition (aOR 4.33, 2.56\u20137.33), recurrent pneumonia (aOR 1.82, 1.18\u20132.81), cyanosis (aOR 24.02, 7.41\u201377.87), chest indrawing (aOR 4.19, 2.73\u20136.43), and higher NLR (per 1 unit: aOR 1.49, 1.38\u20131.60), while tachypnea was not independently associated after adjustment. Discrimination improved from Model 1 (AUC 0.754) to Model 2 (AUC 0.840; 95% CI 0.806\u20130.874). At the optimal probability cut-off (0.122), Model 2 achieved sensitivity 66.2%, specificity 86.2%, PPV 31.1%, NPV 96.5%, and accuracy 84.5%. Calibration was acceptable (Hosmer\u2013Lemeshow p = 0.662; O:E = 1.00). Conclusions: A simple clinical model strengthened by NLR provided good discrimination and calibration for predicting respiratory support requirement among children under-five hospitalized with pneumonia in Southern Vietnam. This approach may support early triage, prioritization of monitoring intensity, and escalation readiness in resource-constrained settings, although external validation is warranted.<\/jats:p>","DOI":"10.3390\/jcm15072490","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T09:11:14Z","timestamp":1774429874000},"page":"2490","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prediction of In-Hospital Respiratory Support Among Children Aged 2\u201359 Months Hospitalized with Pneumonia in Southern Vietnam: A Retrospective Cohort Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8377-0217","authenticated-orcid":false,"given":"Thi Van","family":"Vo","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, No. 179 Nguyen Van Cu Street, Tan An Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3857-9420","authenticated-orcid":false,"given":"Phuong Minh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, No. 179 Nguyen Van Cu Street, Tan An Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8025-3692","authenticated-orcid":false,"given":"Dien Tri","family":"Lu","sequence":"additional","affiliation":[{"name":"Internal Medicine Program, Department of General Nursing, Faculty of Nursing and Medical Technology, Can Tho University of Medicine and Pharmacy, No. 179 Nguyen Van Cu Street, Tan An Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2815-2278","authenticated-orcid":false,"given":"Thanh Huy","family":"Ong","sequence":"additional","affiliation":[{"name":"Can Tho Children\u2019s Hospital, No. 345 Nguyen Van Cu Street, An Binh Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9356-6846","authenticated-orcid":false,"given":"Tri Duc","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Can Tho Children\u2019s Hospital, No. 345 Nguyen Van Cu Street, An Binh Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7007-8485","authenticated-orcid":false,"given":"Dien Minh","family":"Thai","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Nam Can Tho University, No. 168 Nguyen Van Cu Street, An Binh Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0400-8773","authenticated-orcid":false,"given":"Duc Hoang Minh","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Faculty of Medicine, Can Tho University of Medicine and Pharmacy, No. 179 Nguyen Van Cu Street, Tan An Ward, Can Tho 900000, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"ref_1","first-page":"S4","article-title":"Essential Interventions for Child Health","volume":"11","author":"Lassi","year":"2014","journal-title":"Reprod. 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