Clinical predictors of hypoxemia in children with WHO classified pneumonia

Abstract

Background: In developing countries were health providers have to rely on signs and symptoms to identify hypoxemia in pneumonia and start oxygen therapy, this study was therefore conducted to assess the prevalence and predictors of hypoxemia with the hypothesis to design a severity score for hypoxemia in children with pneumonia.Methods: This prospective observational study was carried out at the paediatric emergency department of Gajra Raja Medical College, Gwalior, on children of age 1-60 months admitted with respiratory illness categorised on basis of “Revised WHO Classification of Pneumonia”. Various demographic and clinical features were noted. Oxygen saturation was measured via a pulse oximeter. Hypoxemia was defined as SpO2 <90%. Statistical analysis was done.Results: Of the 200 children studied, 67 (33.5%) had hypoxemia. Fever, breathing difficulty, and crepitations were the most sensitive, while inability to feed, cyanosis, grunting, head nodding and impaired consciousness were the most specific indicators for hypoxemia. Fever, lethargy, inability to feed, nasal flaring, grunting, impaired consciousness and cyanosis were found significant (p value<0.05). Combinations of tachypnea with nasal flaring, grunting, cyanosis, and retractions with grunting were also found significant in predicting hypoxemia. Combinations of tachypnea with grunting (90.2%) and cyanosis (94.7%) were found highly specific. Using these combinations, a new hypoxemia scoring system was designed to predict the severity of hypoxemia.Conclusions: Study suggested that combination of clinical signs may be utilized as markers for hypoxemia in conditions where pulse-oximeter is not available.

Hypoxemia and its clinical predictors among children with respiratory distress admitted to the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

“…The prevalence of hypoxemia in this study was higher than other studies conducted in Ethiopia (57.0%) [ 17 ], Colombia (47%) [ 19 ], Nepal (38.5%) [ 20 ], another study in Nepal (51%) [ 21 ], India (33.5%) [ 22 ] Peru (10%) [ 13 ], and the Netherlands (45%) [ 14 ]. This discrepancy might be due to variations in the health care system, variations in access to adequate healthcare services, health care facilities, and variations in the habit of proper hygiene and sanitation, which leads to respiratory tract infection, unclean water, inadequate access to food, which leads to immune suppression, and low levels of immunization coverage.…”

Comparison of Various Methods of Detection of Hypoxemia and Correlation of Hypoxemia with Clinical Features among Pediatric Patients 3 Months to 5 Years Old with Community-Acquired Pneumonia at a Tertiary Hospital Emergency Room

“…These findings are consistent with previous studies conducted on predictors of hypoxemia. 18,19,20,21,22 Final prediction model in this study showed difficulty in breathing as a final predictor of hypoxemia.…”

“…17 of hypoxemia in children with pneumonia may be due to differences in characteristics of study populations, severity of pneumonia, cut-off values and definitions of hypoxemia, methods of measurement of hypoxemia, presence of comorbid conditions, and geographic region and altitude of study setting. 16,18 Numerous studies have recognized the need to identify predictors of hypoxemia in resourcelimited settings, each with varying results. This present study identified difficulty breathing, tachypnea, and subcostal retractions as significantly more likely to be observed in those with hypoxemia.…”

Prevalence and Clinical Predictors of Severe Pneumonia among School-Aged Children: A Systematized Review

“…A decrease in oxygen pressure in the blood, a condition called hypoxemia, is often a result of pneumonia but may also result from other conditions such as asthma (Sarkar et al, 2017). Studies have shown that doctors in developing countries have found the inability to eat, cyanosis, grunting, and impaired consciousness to be among the most accurate clinical predictors of hypoxemia caused by pneumonia (Kushwah & Gaur, 2018). Although pneumonia is the most common cause of death in children, its symptoms and signs easily overlap with other respiratory and non-respiratory diseases such as malaria, making it difficult to diagnose (Scott et al, 2012).…”