Determinants of hypoxemia in children associated with pneumonia

Ramawat, Pramila; Sharma, Balkishan

doi:10.3126/ajms.v7i2.13049

Cited by 4 publications

(6 citation statements)

References 15 publications

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“…The high sensitivity of fever, difficulty in breathing and cough was comparable with previous studies, while inability to feed was found specific as supported by Sah HD. 17,20,23 Findings of the present study revealed that cyanosis had a very high association whereas grunting; chest retractions, nasal flaring and impaired consciousness were significantly associated with hypoxemia which is supported by various other studies as reported by the study by Onyango et al 3,18,24 Sah HD also highlighted different predictors for hypoxemia which were inability to feed and drink lethargy, tachypnea, and central cyanosis, chest in-drawing and grunting. 23 This research has shown that the cyanosis (94.737%), head nodding (96.99%), grunting (90.22%) were highly specific but all were less sensitive sign as seen variably in the previous studies.…”

Section: Discussionsupporting

confidence: 86%

“…The prevalence of hypoxemia was significantly more (42.8%) in severe pneumonia as compared to 24.5% in pneumonia, comparable previous studies. 17,20 The results were not comparable with the study of Alwadhi et al (50.9%) because of the fact that the definition of severe pneumonia used in their study was based on IMNCI guidelines, which uses a syndromic approach to identify sick children unlike the WHO algorithm used in present study. 21 The study showed the increasing sensitivity with higher respiratory rate and a statistical association of tachypnea with hypoxemia comparable to previous studies which showed that age specific increase in respiratory rate, were single most useful signs to predict hypoxemia.…”

Section: Discussioncontrasting

confidence: 79%

“…21 The study showed the increasing sensitivity with higher respiratory rate and a statistical association of tachypnea with hypoxemia comparable to previous studies which showed that age specific increase in respiratory rate, were single most useful signs to predict hypoxemia. 11,17,20 This study had high sensitivity for tachypnea as in the study done by Motwani et al but lack specificity unlike Mulholand et al due to influence of fever over the respiratory rate. 11,18 The present study had 21.5% children under severe acute malnutrition (SAM), comparable with the study of Alwadhi et al 21 Malnourished children may be unable to exhibit chest indrawing, because of reduced serum potassium, magnesium and calcium levels, which may contribute to the reduced strength of accessory respiratory muscles and have generalized muscle wasting and hypotonia.…”

Section: Discussionmentioning

confidence: 70%

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Clinical predictors of hypoxemia in children with WHO classified pneumonia

Kushwah¹,

Verma²,

Gaur³

2018

Int J Contemp Pediatr

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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.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 70%

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Clinical predictors of hypoxemia in children with WHO classified pneumonia

Kushwah¹,

Verma²,

Gaur³

2018

Int J Contemp Pediatr

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“…A similar cross-sectional study on determinants of hypoxemia in children associated with pneumonia by Ramawat and Sharma (2015) revealed that the prevalence of hypoxemia was 48% (29). As compared to our study, the cross-sectional study by Ramawat and Sharma (2015) found that the incidence of POH is comparable, even though differences in study design exist and is higher than the study done by Kumar Rao et al (2012). This might be due to the fact that it took into account only pediatric patients with acute respiratory tract infections.…”

Section: Discussioncontrasting

confidence: 49%

“…The prevalence of hypoxemia was found to be 23.8% in a cross-sectional study conducted by Kumar Rao et al ( 2012) on clinical predictors of hypoxemia in Indian children coming to the pediatric emergency room with an acute respiratory tract infection (28). A similar cross-sectional study on determinants of hypoxemia in children associated with pneumonia by Ramawat and Sharma (2015) revealed that the prevalence of hypoxemia was 48% (29). As compared to our study, the cross-sectional study by Ramawat and Sharma (2015) found that the incidence of POH is comparable, even though differences in study design exist and is higher than the study done by Kumar Rao et al (2012).…”

Section: Discussionsupporting

confidence: 47%

Incidence and Predictors of Post-operative Hypoxemia in Pediatric Patients Undergoing General Anesthesia: a Single-arm Prospective Multi-center Cohort Study 2023

Mengistu,

Mulugeta,

Destaw

et al. 2024

Preprint

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Background: Pediatrics use more oxygen than adults do, which has an impact on how quickly the body desaturates after an apnea. Depending on age and other physiological parameters, the clinically relevant hypoxemia in pediatric patients can drop to 40% in as little as 1.5 minutes, which makes the transfer to the Post-Anesthesia Care Unit (PACU) a risky phase. Postoperative hypoxemia (POH) happens critically postoperatively and various factors predict POH. The objective of the study is to determine the incidence and predictors of POH in pediatric patients undergoing general anesthesia (GA) at Hawassa University Comprehensive Specialized Hospital (HUCSH), Saint Peter Specialized Hospital, and Tikur Anbessa Specialized Hospital (TASH) Methodology: In 292 pediatric patients, a single-arm prospective multi-center cohort study using systematic random sampling was carried out. Data entry and analysis were performed using Statistical Package for Social Sciences (SPSS) version 25.00 software. For logistic regression, a Hosmer-Lemeshow goodness of fit test was used (variables with a p > 0.05 were considered fit). Binomial logistic regression and multivariable analysis were performed. Independent variables were examined for multicollinearity, and those exhibiting a variance inflation factor (VIF) > 10 were removed. Additionally, the association between the variables was determined using Pearson chi-square, and p < 0.05 indicated statistically significant variables. Results: The incidence of POH was 47.9%. Pediatric age (≤ 2 years), opioids, and above-abdominal surgeries are associated with POH (p = < 0.001) and AOR = 3.263 (1.686–6.314), 5.545 (2.983–10.307), and 3.642 (1.969–6.736), respectively. Additionally, the presence of at least one comorbidity, use of muscle relaxants, prolonged anesthesia, and surgery duration are associated with POH (p = 0.001, 0.003, 0.02, and 0.037) and AOR = 4.259 (1.788–10.145), 29.72 (3.262–270.778), 2.153 (1.131–4.1), and 2.560 (1.058–6.196), respectively. However, anesthesia type is insignificantly associated with POH (p = 0.096). Conclusion:The incidence of POH in pediatric patients undergoing GA is high, and the presence of at least one comorbidity, pediatric age (≤ 2 years), use of opioids and muscle relaxants, above-abdominal surgeries, prolonged anesthesia, and surgery durations are significantly associated with POH. We recommend taking precautions, following them and having oxygen therapy for these high-risk pediatric patients.

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