title: Clinical predictors and outcome of hypoxaemia among under-five diarrhoeal children with or without pneumonia in an urban hospital, Dhaka, Bangladesh.
abstract: OBJECTIVE
  To explore the predictors and outcome of hypoxaemia in children under 5 years of age who were hospitalized for the management of diarrhoea in Dhaka, where comorbidities are common.
  
  
  METHODS
  In a prospective cohort study, we enrolled all children <5 years of age admitted to the special care ward (SCW) of the Dhaka Hospital of ICDDR,B from September to December 2007. Those who presented with hypoxaemia (SpO(2) < 90%) constituted the study group, and those without hypoxaemia formed the comparison group.
  
  
  RESULTS
  A total of 258 children were enrolled, all had diarrhoea. Of the total, 198 (77%) had pneumonia and 106 (41%) had severe malnutrition (<-3 Z-score of weight for age of the median of the National Centre for Health Statistics), 119 (46%) had hypoxaemia and 138 children did not have hypoxaemia at the time of admission. Children with hypoxaemia had a higher probability of a fatal outcome (21%vs. 4%; P < 0.001). Using logistic regression analysis, the independent predictors of hypoxaemia at the time of presentation were lower chest wall indrawing [OR 6.91, 95% confidence intervals (CI) 3.66-13.08, P < 0.001], nasal flaring (OR 3.22, 95% CI 1.45-7.17, P = 0.004) and severe sepsis (OR 4.48, 95% CI 1.62-12.42, P = 0.004).
  
  
  CONCLUSIONS
  In this seriously ill population of children with diarrhoea and comorbidities, hypoxaemia was associated with high case-fatality rates. Independent clinical predictors of hypoxaemia in this population, identifiable at the time of admission, were lower chest wall indrawing, nasal flaring and the clinical syndrome of severe sepsis.
authors.affiliation: Clinical Sciences Division, ICDDR,B, Dhaka, Bangladesh. chisti@icddrb.org
authors.forename: Mohammod J
authors.initials: MJ
authors.lastname: Chisti
authors.forename: Trevor
authors.initials: T
authors.lastname: Duke
authors.forename: Colin F
authors.initials: CF
authors.lastname: Robertson
authors.forename: Tahmeed
authors.initials: T
authors.lastname: Ahmed
authors.forename: Abu S G
authors.initials: AS
authors.lastname: Faruque
authors.forename: Hasan
authors.initials: H
authors.lastname: Ashraf
authors.forename: Sophie
authors.initials: S
authors.lastname: La Vincente
authors.forename: Pradip K
authors.initials: PK
authors.lastname: Bardhan
authors.forename: Mohammed A
authors.initials: MA
authors.lastname: Salam
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D001835:Body Weight; D016022:Case-Control Studies; D002675:Child, Preschool; D016001:Confidence Intervals; D003967:Diarrhea / Q000150:complications* / Q000453:epidemiology; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000401:mortality; D007223:Infant; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000453:epidemiology; D009666:Nose; D016017:Odds Ratio; D011014:Pneumonia / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology; D013909:Thorax