Hypoxemia in children with pneumonia and its clinical predictors.
OBJECTIVE
To assess the prevalence of hypoxemia in children, 2 months to 5 years of age, with pneumonia and to identify its clinical predictors.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Basnet
Sudha
S
Department of Pediatrics, Institute of Medicine, Kathmandu, Nepal. sudhab@healthnet.org.np
Adhikari
Ramesh Kant
RK
Gurung
Chitra Kumar
CK
D002675:Child, Preschool; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000453:epidemiology / Q000209:etiology*; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D011014:Pneumonia / Q000150:complications* / Q000503:physiopathology*; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index