Epidemiology of Hypoxic Community-Acquired Pneumonia in Children Under 5 Years of Age: An Observational Study in Northern India

Abstract

BackgroundCommunity-acquired pneumonia (CAP) is the leading cause of under-five mortality in India. An increased risk of mortality has been reported in cases of hypoxic pneumonia.MethodsThe primary objective of this study was to assess the proportion of children aged 2–59 months, hospitalized with hypoxic CAP, as well as socio-demographic, clinical, and radiological features associated with it. The secondary objective was to determine the risk of mortality among hospitalized cases of hypoxic CAP. This prospective, observational study was conducted in four districts of Northern India, between January 2015 and April 2021. A hospital-based surveillance network was established. Inclusion criteria were as follows: (a) child between 2 and 59 months, (b) hospitalization with symptoms of WHO-defined CAP, (c) resident of project district, (d) illness of <14 days, and (e) child had neither been hospitalized for this illness nor recruited previously. Children whose chest x-rays (CXRs) were either unavailable/un-interpretable and those that received any dose of pneumococcal conjugate vaccine-13 were excluded. Hypoxic pneumonia was defined as oxygen saturation <90% on pulse oximetry or requiring oxygen supplementation during hospital stay.ResultsDuring the study period, 71.9% (7,196/10,006) children of severe pneumonia were eligible for inclusion, of whom 35.9% (2,580/7,196) were having hypoxic pneumonia. Female gender and use of biomass fuel for cooking increased the odds of hypoxic CAP. Clinical factors like wheezing, pallor, tachypnea, low pulse volume, presence of comorbidity, general danger signs, severe malnutrition, and radiological finding of primary end-point pneumonia ± other infiltrates (PEP±OI) also increased the odds of hypoxic CAP in a conditional logistic regression model. Adjusted odds ratio for mortality with hypoxia was 2.36 (95% CI: 1.42–3.92).ConclusionAlmost one-third of cases hospitalized with severe CAP had hypoxia, which increased chances of mortality. Besides known danger signs, certain newer clinical signs such as pallor and wheezing as well as PEP+OI were associated with hypoxic CAP. Therefore, objective assessment of oxygen saturation must be done by pulse oximetry in all cases of CAP at the time of diagnosis.

Should we have any predictive marker for estimating the severity of community-acquired pneumonia at admission?

“…They recommended using oxygen saturation and objective data to determine the severity of pneumonia (24). The study by Awasthi et al (28) emphasised that hypoxia and pneumonia in children under five years of age increase the mortality rate and may cause severe pneumonia. In their research, Modi et al (29) emphasised that the sensitivity of the oxygen saturation measurement in evaluating pneumonia is more predictive than other clinical findings in resourceconstrained conditions.…”

Effectiveness of 13-valent pneumococcal conjugate vaccine on radiological primary end-point pneumonia among cases of severe community acquired pneumonia in children: A prospective multi-site hospital-based test-negative study in Northern India

“…Malnutrition status were categorized as WAZ >-2SD (normal), WAZ ≤ -2SD (malnourished) and WAZ ≤ -3SD (severe malnutrition) [ 17 ]. Hypoxia was defined as oxygen saturation<90% on pulse oximetry or requiring oxygen supplementation during hospital stay [ 18 , 19 ]. Since respiratory syncytial virus (RSV) tends to peak in India in five months of early winter (June to October) and three months of winter (December to February), therefore these eight months were considered as RSV season [ 20 ].…”

Childhood Pneumonia: What’s Unchanged, and What’s New?

“…Hypoxia is an important determinant of mortality and needs to be identified early and managed on priority. A recent study done by Awasthi et al reported 35.9% of 7196 under-five children hospitalised with WHO defined severe pneumonia had hypoxia among those unvaccinated with PCV13 [ 41 ]. Oxygen saturation <90% on pulse oximetry or requiring oxygen therapy during hospital stay was considered as hypoxic.…”