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Cardiovascular abnormalities in chest radiographs of children with pneumonia, Uganda
Eva Nabawanuka1, Faith Ameda1, Geoffrey Erem1
1Department of Radiology, School of Medicine, Makerere University, PO Box 7051, Kampala, Uganda.
Insights
Radiological pneumonia and cardiovascular abnormalities are common in Ugandan children hospitalized with severe pneumonia. Chest X-rays are crucial for accurate diagnosis and management in resource-limited settings.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Global Health
Background:
- Severe pneumonia and hypoxemia are significant causes of childhood mortality in resource-limited settings.
- Clinical diagnosis of pneumonia in children can be challenging, lacking specificity.
Purpose of the Study:
- To characterize chest radiograph findings in children hospitalized with severe pneumonia and hypoxemia in Uganda.
- To evaluate the utility of chest radiography in diagnosing pneumonia and associated conditions.
Main Methods:
- A random sample of 375 children (28 days to 12 years) hospitalized with hypoxemia (SpO2 < 92%) were included.
- Chest radiographs were interpreted by blinded radiologists using the WHO standardized method.
- Clinical and radiograph data were analyzed using descriptive statistics.
Main Results:
- 45.9% of children had radiological pneumonia; 32.8% had other abnormalities.
- Cardiovascular abnormalities were present in 28.3% of children, with 14.9% having both pneumonia and other abnormalities.
- No significant difference in pneumonia or cardiovascular abnormality prevalence was found between severe and mild hypoxemia groups.
Conclusions:
- Cardiovascular abnormalities are common in children with severe pneumonia in Uganda.
- Clinical criteria for pneumonia lack specificity in resource-poor settings.
- Routine chest radiography is recommended for children with suspected severe pneumonia to assess both respiratory and cardiovascular systems.
Objective:
To describe chest radiograph findings among children hospitalized with clinically diagnosed severe pneumonia and hypoxaemia at three tertiary facilities in Uganda.
Methods:
The study involved clinical and radiograph data on a random sample of 375 children aged 28 days to 12 years enrolled in the Children's Oxygen Administration Strategies Trial in 2017. Children were hospitalized with a history of respiratory illness and respiratory distress complicated by hypoxaemia, defined as a peripheral oxygen saturation (SpO2) < 92%. Radiologists blinded to clinical findings interpreted chest radiographs using standardized World Health Organization method for paediatric chest radiograph reporting. We report clinical and chest radiograph findings using descriptive statistics.
Findings:
Overall, 45.9% (172/375) of children had radiological pneumonia, 36.3% (136/375) had a normal chest radiograph and 32.8% (123/375) had other radiograph abnormalities, with or without pneumonia. In addition, 28.3% (106/375) had a cardiovascular abnormality, including 14.9% (56/375) with both pneumonia and another abnormality. There was no significant difference in the prevalence of radiological pneumonia or of cardiovascular abnormalities or in 28-day mortality between children with severe hypoxaemia (SpO2: < 80%) and those with mild hypoxaemia (SpO2: 80 to < 92%).
Conclusion:
Cardiovascular abnormalities were relatively common among children hospitalized with severe pneumonia in Uganda. The standard clinical criteria used to identify pneumonia among children in resource-poor settings were sensitive but lacked specificity. Chest radiographs should be performed routinely for all children with clinical signs of severe pneumonia because it provides useful information on both cardiovascular and respiratory systems.
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