Objectives: To determine clinical correlates and outcome of hypoxaemia in children admitted to hospital with an acute lower respiratory tract infection.
Design: Prospective cohort study.
Setting: Paediatric wards of the Royal Victoria Hospital and the hospital of the Medical Research Council's hospital in Banjul, the Gambia.
Subjects: 1072 of 42 848 children, aged 2 to 33 months, who were enrolled in a randomised trial of a Haemophilus influenzae type b vaccine in the western region of the Gambia, and who were admitted with an acute lower respiratory tract infection to two of three hospitals.
Main outcome measures: Prevalence of hypoxaemia, defined as an arterial oxygen saturation <90% recorded by pulse oximetry, and the relation between hypoxaemia and aetiological agents.
Results: 1072 children aged 2-33 months were enrolled. Sixty three (5.9%) had an arterial oxygen saturation <90%. A logistic regression model showed that cyanosis, a rapid respiratory rate, grunting, head nodding, an absence of a history of fever, and no spontaneous movement during examination were the best independent predictors of hypoxaemia. The presence of an inability to cry, head nodding, or a respiratory rate >/= 90 breaths/min formed the best predictors of hypoxaemia (sensitivity 70%, specificity 79%). Hypoxaemic children were five times more likely to die than non-hypoxaemic children. The presence of malaria parasitaemia had no effect on the prevalence of hypoxaemia or on its association with respiratory rate.
Conclusion: In children with an acute lower respiratory tract infection, simple physical signs that require minimal expertise to recognise can be used to determine oxygen therapy and to aid in screening for referral. The association between hypoxaemia and death highlights the need for early recognition of the condition and the potential benefit of treatment.
PIP: Acute lower respiratory tract (ALRT) infections cause considerable child morbidity and mortality in developing countries. Oxygen therapy can improve the outcome of children with moderate or severe ALRT infections and, in those with hypoxemia, the severity of hypoxia correlates with outcome. However, since oxygen is not always available in resource-poor countries, rational guidelines must be followed for the use of oxygen and the referral of patients to specialist hospitals. Findings are presented from a prospective cohort study conducted to determine which clinical signs predict hypoxemia and the outcome of hypoxemia among children admitted to hospital with ALRT infection. Findings are based upon the study of 1072 of 42,848 children aged 2-33 months who were enrolled in a randomized trial of a Haemophilus influenzae type b vaccine in western Gambia, and who were admitted with an ALRT infection to 2 of 3 hospitals. 63 (5.9%) had an arterial oxygen saturation level of less than 90%. Logistic regression found cyanosis, a rapid respiratory rate, grunting, head nodding, absence of a history of fever, and no spontaneous movement during examination were significantly associated with hypoxemia. When cyanosis may not be correctly assessed, the inability to cry, head nodding, and a respiratory rate of at least 90 breaths/minute can be useful ways of predicting hypoxemia. Hypoxemic children were 5 times more likely to die than were nonhypoxemic children. The presence of malaria parasitemia had no effect upon the prevalence of hypoxemia or upon its association with respiratory rate.