DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20181981

Clinical predictors of hypoxemia in children with WHO classified pneumonia

Meenakshi S. Kushwah, Yogendra S. Verma, Ajay Gaur

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.


Keywords


Hypoxemia, Hypoxemic score, Pulse oximetry, Pneumonia

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References


Singhi S, Deepa A, Kaur H, Prevalence and predictors of hypoxemia in acute respiratory infections presenting in pediatric emergency department. Indian J Crit Care Med. 2003;7:118-23.

Lodha R, Bhadauria PS, Kuttikat AV, Puranik M, Gupta S, Pandey RM, et al. Can clinical symptoms or signs accurately predict hypoxemia in children with acute lower respiratory tract infection? Indian Pediatr. 2004;41:129-35.

Onyango FE, Steinoff MC, Wafula EM, Wariera, Musia J, Kitonia J. Hypoxemia in young Kenyan children with ALRI. BMJ. 1993;306:612-4.

Duke T, Frank D., Mgone J, Hypoxemia in children with severe pneumonia in Papua New Guinea, Int J Tuberc Lung Dis. 2000;5:511-9.

Weber MW, Usen S, Palmer A, Jaffar S, Mulholland EK. Predictors of hypoxemia in hospital admission with ALRI in developing countries. Arch Dis Child. 1997;76:1-5.

Duke T, Blaschke AJ, Sialis S, Bonkowsky JL. Hypoxemia in acute respiratory andnon respiratory illness in neonates and children in developing countries. Arch Dis Child. 2002;86:108-12

Levene S, Mckenzie SA. Pulse oxymetry in children. Lancet. 1988;1:415-6.

Neff TA. Routine oximetry. Chest. 1988;94:227.

Cherian T, John TJ, Simoes E, Steinhoff MC. John M. Evaluation of simple clinical signs for the diagnosis of acute lower respiratory tract infection. Lancet. 1988;1:125-8.

Reuland DS, Steinhoff MC, Gilman RH, Bara M, Olivares EF, Jabra A et al. Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes. J Pediatr. 1991 199: 900-7.

Mulholland EK, Olinsky A. Shann FA. Clinical findings and severity of acute bronchiolitis. Lancet. 1990;335:1259-61.

Hall CG, Hall WJ, Speers DM, Clinical and physiological manifestations of bronchiolitis and pneumonia. Outcome of respiratory syncytial virus, AM J Dis Child. 1979;133:798-802.

Dyke T, Lewis D, Heegaard W, Manary M, Flwe S. Rudeen K, Predicting hypoxia in children with acute lower respiratory infection: a study in the highlands or Papua New-Guinea. J Trop Pediatr. 1995.41;196-201.

Lozano JM, Steinhoff M, Ruiz JG, Meza ML, Martinez N, Dussan B. Clinical predictors of acute radiological pneumonia and hypoxaemia at high altitude. Arch Dis Child. 1994;71:323-7.

Hockenberry MJ, Wilson D. Wong's nursing care of infants and children-E-book. Elsevier Health Sciences; 2014.

WHO, oxygen therapy for children, Hypoxemia and hypoxia. 2016; 4-5.

Basnet S., Adhikari R.K. and Gurung CK, Hypoxemia in children with pneumonia and its clinical predictors. Indian J Pediatri. 2008;73:777-81.

Motwani Naresh P, Janakiraman L, Bala S, Bhawnani D. Clinical Predictors of Hypoxemia in Children with Acute Lower Respiratory Illness. Int Res J Med Sci. 2015;3:11-5.

Made S, Putu Siadi P, Koni N, Ida Bagus S. Clinical predictors of hypoxemia in 1-5-year-old children with pneumonia. Pediatric Indones. 2010; 50:355-60.

Ramawat P, Sharma B. Determinants of hypoxemia in children associated with pneumonia. Asian J Med Sci. 2015;7:64-70.

Alwadhi V, Dewan P, Malhotra RK, Shah D, Gupta P. Tachypnea and Other Danger Signs vs Pulse Oximetry for Prediction of Hypoxia in Severe Pneumonia/Very Severe Disease. Indian Pediatr. 2017;54:729-34.

Chisti MJ, Salam MA, Ashraf H, Faruque AS, Bardhan PK, Shahid AS, et al. Predictors and outcome of hypoxemia in severely malnourished children under five with pneumonia: A case control design. PLoS One. 2013;8:e51376.

Sah H. Study of predictors of hypoxemia in children with Pneumonia. J Coll Med Sci. 2014:9,1-8.

Kuti BP, Adegoke SA, Ebruke BE, Howie S, Oyelami OA, Ota M. Determinants of oxygen therapy in childhood pneumonia in a resource-constrained region. Pediatrics. 2013.

Agrawal K, Mahaseth C and Rayamajhi A. Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants under 2 months of Age. J Nepal Paediatr Soc. 2011;31:202-8.