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Hypoxaemia in young Kenyan children with acute lower respiratory infection
F E Onyango1, M C Steinhoff, E M Wafula
1Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
Insights
Over half of acutely ill children with respiratory symptoms were hypoxaemic, significantly increasing mortality risk. Specific clinical signs can help predict hypoxaemia in these children.
Area of Science:
- Pediatrics
- Pulmonology
- Global Health
Background:
- Hypoxaemia is a critical complication in acutely ill children with respiratory symptoms.
- Understanding its prevalence and predictors is vital for timely intervention, especially in resource-limited settings.
Purpose of the Study:
- To determine the prevalence, clinical correlates, and outcome of hypoxaemia in acutely ill children presenting with respiratory symptoms.
- To identify clinical signs predictive of hypoxaemia in this population.
Main Methods:
- Prospective observational study conducted in a pediatric casualty ward in Nairobi, Kenya.
- Included 256 infants and children under 3 years with respiratory infections.
- Hypoxaemia defined as arterial oxygen saturation < 90% by pulse oximetry.
Main Results:
- Over half (151) of the children were hypoxaemic, with a 4.3 times greater short-term mortality risk.
- Specific clinical signs like high respiratory rate, grunting, and retractions predicted hypoxaemia in infants.
- High respiratory rate was the best predictor in older children.
Conclusions:
- Hypoxaemia is highly prevalent in acutely ill children with respiratory symptoms in this setting.
- Clinical signs can effectively predict hypoxaemia, aiding in early detection and management.
- Effective management of hypoxaemia is crucial for reducing mortality in pediatric lower respiratory tract infections in developing regions.
Objectives:
To determine the prevalence, clinical correlates, and outcome of hypoxaemia in acutely ill children with respiratory symptoms.
Design:
Prospective observational study.
Setting:
Paediatric casualty ward of a referral hospital at 1670 m altitude in Nairobi, Kenya.
Subjects:
256 Infants and children under 3 years of age with symptoms of respiratory infection.
Main Outcome Measures:
Prevalence of hypoxaemia, defined as arterial oxygen saturation < 90% determined by pulse oximetry, and condition of patient on the fifth day after admission.
Results:
Over half (151) of the children were hypoxaemic, and short term mortality was 4.3 times greater in these children. In contrast, the relative risk of a fatal outcome in children with radiographic pneumonia was only 1.03 times that of children without radiographic pneumonia. A logistic regression model showed that in 3-11 month old infants a respiratory rate > or = 70/min, grunting, and retractions were the best independent clinical signs for the prediction of hypoxaemia. In the older children a respiratory rate of > or = 60/min was the single best clinical predictor of hypoxaemia. The presence of hypoxaemia predicted radiographic pneumonia with a sensitivity of 71% and specificity of 55%.
Conclusions:
Over half the children presenting to this referral hospital with respiratory symptoms were hypoxaemic. A group of specific clinical signs seem useful in predicting hypoxaemia. The clear association of hypoxaemia with mortality suggests that the detection and effective treatment of hypoxaemia are important aspects of the clinical management of acute infections of the lower respiratory tract in children in hospital in developing regions.