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. 1993 Mar 6;306(6878):612–615. doi: 10.1136/bmj.306.6878.612

Hypoxaemia in young Kenyan children with acute lower respiratory infection.

F E Onyango 1, M C Steinhoff 1, E M Wafula 1, S Wariua 1, J Musia 1, J Kitonyi 1
PMCID: PMC1676956  PMID: 8369033

Abstract

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.

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Selected References

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  1. Banks R. A., George R. C., McNicol M. W. Pneumococcal pneumonia with bacteraemia. Br J Dis Chest. 1984 Oct;78(4):352–357. [PubMed] [Google Scholar]
  2. Berman S., Shanks M. B., Feiten D., Horgan J. G., Rumack C. Acute respiratory infections during the first three months of life: clinical, radiologic and physiologic predictors of etiology. Pediatr Emerg Care. 1990 Sep;6(3):179–182. doi: 10.1097/00006565-199009000-00003. [DOI] [PubMed] [Google Scholar]
  3. Campbell H., Byass P., Lamont A. C., Forgie I. M., O'Neill K. P., Lloyd-Evans N., Greenwood B. M. Assessment of clinical criteria for identification of severe acute lower respiratory tract infections in children. Lancet. 1989 Feb 11;1(8633):297–299. doi: 10.1016/s0140-6736(89)91308-1. [DOI] [PubMed] [Google Scholar]
  4. Farr B. M., Sloman A. J., Fisch M. J. Predicting death in patients hospitalized for community-acquired pneumonia. Ann Intern Med. 1991 Sep 15;115(6):428–436. doi: 10.7326/0003-4819-115-6-428. [DOI] [PubMed] [Google Scholar]
  5. Green M., Brayer A. F., Schenkman K. A., Wald E. R. Duration of hospitalization in previously well infants with respiratory syncytial virus infection. Pediatr Infect Dis J. 1989 Sep;8(9):601–605. doi: 10.1097/00006454-198909000-00007. [DOI] [PubMed] [Google Scholar]
  6. Hall C. B., Hall W. J., Speers D. M. Clinical and physiological manifestations of bronchiolitis and pneumonia. Outcome of respiratory syncytial virus. Am J Dis Child. 1979 Aug;133(8):798–802. doi: 10.1001/archpedi.1979.02130080038006. [DOI] [PubMed] [Google Scholar]
  7. Hook E. W., 3rd, Horton C. A., Schaberg D. R. Failure of intensive care unit support to influence mortality from pneumococcal bacteremia. JAMA. 1983 Feb 25;249(8):1055–1057. [PubMed] [Google Scholar]
  8. Mulholland E. K., Olinsky A., Shann F. A. Clinical findings and severity of acute bronchiolitis. Lancet. 1990 May 26;335(8700):1259–1261. doi: 10.1016/0140-6736(90)91314-z. [DOI] [PubMed] [Google Scholar]
  9. Mulholland E. K., Simoes E. A., Costales M. O., McGrath E. J., Manalac E. M., Gove S. Standardized diagnosis of pneumonia in developing countries. Pediatr Infect Dis J. 1992 Feb;11(2):77–81. doi: 10.1097/00006454-199202000-00004. [DOI] [PubMed] [Google Scholar]
  10. REYNOLDS E. O. THE EFFECT OF BREATHING 40 PER CENT OXYGEN ON THE ARTERIAL BLOOD GAS TENSIONS OF BABIES WITH BRONCHIOLITIS. J Pediatr. 1963 Dec;63:1135–1139. doi: 10.1016/s0022-3476(63)80196-1. [DOI] [PubMed] [Google Scholar]
  11. Ransohoff D. F., Feinstein A. R. Problems of spectrum and bias in evaluating the efficacy of diagnostic tests. N Engl J Med. 1978 Oct 26;299(17):926–930. doi: 10.1056/NEJM197810262991705. [DOI] [PubMed] [Google Scholar]
  12. Reuland D. S., Steinhoff M. C., Gilman R. H., Bara M., Olivares E. G., Jabra A., Finkelstein D. Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes. J Pediatr. 1991 Dec;119(6):900–906. doi: 10.1016/s0022-3476(05)83040-9. [DOI] [PubMed] [Google Scholar]
  13. Rosen L. M., Yamamoto L. G., Wiebe R. A. Pulse oximetry to identify a high-risk group of children with wheezing. Am J Emerg Med. 1989 Nov;7(6):567–570. doi: 10.1016/0735-6757(89)90275-1. [DOI] [PubMed] [Google Scholar]
  14. Shann F., Barker J., Poore P. Clinical signs that predict death in children with severe pneumonia. Pediatr Infect Dis J. 1989 Dec;8(12):852–855. doi: 10.1097/00006454-198912000-00005. [DOI] [PubMed] [Google Scholar]
  15. Shann F., Hart K., Thomas D. Acute lower respiratory tract infections in children: possible criteria for selection of patients for antibiotic therapy and hospital admission. Bull World Health Organ. 1984;62(5):749–753. [PMC free article] [PubMed] [Google Scholar]
  16. Shaw K. N., Bell L. M., Sherman N. H. Outpatient assessment of infants with bronchiolitis. Am J Dis Child. 1991 Feb;145(2):151–155. doi: 10.1001/archpedi.1991.02160020041012. [DOI] [PubMed] [Google Scholar]
  17. Thilo E. H., Park-Moore B., Berman E. R., Carson B. S. Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child. 1991 Oct;145(10):1137–1140. doi: 10.1001/archpedi.1991.02160100069025. [DOI] [PubMed] [Google Scholar]

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