Hypoxemia in children with pneumonia and its clinical predictors

Department of Pediatrics, Institute of Medicine, Kathmandu, Nepal.
The Indian Journal of Pediatrics (Impact Factor: 0.87). 09/2006; 73(9):777-81. DOI: 10.1007/BF02790384
Source: PubMed


To assess the prevalence of hypoxemia in children, 2 months to 5 years of age, with pneumonia and to identify its clinical predictors.
Children between 2-60 months of age presenting with a complaint of cough or difficulty breathing were assessed. Hypoxemia was defined as an arterial oxygen saturation of < 90% recorded by a portable pulse oximeter. Patients were categorized into groups: cough and cold, pneumonia, severe pneumonia and very severe pneumonia.
The prevalence of hypoxemia (SpO2 of < 90%) in 150 children with pneumonia was 38.7%. Of them 100% of very severe pneumonia, 80% of severe and 17% of pneumonia patients were hypoxic. Number of infants with respiratory illness (p value = 0.03) and hypoxemia (Odds ratio = 2.21, 95% CI 1.03, 4.76) was significantly higher. Clinical predictors significantly associated with hypoxemia on univariate analysis were lethargy, grunting, nasal flaring, cyanosis, and complaint of inability to breastfeed/drink. Chest indrawing with 68.9% sensitivity and 82.6% specificity was the best predictor of hypoxemia.
The prevalence and clinical predictors of hypoxemia identified validate the WHO classification of pneumonia based on severity. Age < 1 year in children with ARI is an important risk factor for hypoxemia.

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    • "This study of children with diarrhoea and co-morbidities found that lower chest wall indrawing, nasal flaring and the clinical syndrome of severe sepsis are independent indicators of hypoxaemia. While lower chest wall indrawing and nasal flaring have been shown before to be predictors of hypoxaemia (Weber et al. 1997; Usen & Webert 2001; Lodha et al. 2004; Basnet et al. 2006), there has been no previous identification of severe sepsis. "
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