International E-publication: Publish Projects, Dissertation, Theses, Books, Souvenir, Conference Proceeding with ISBN.  International E-Bulletin: Information/News regarding: Academics and Research

Clinical Predictors of Hypoxemia in Children with Acute Lower Respiratory Illness

Author Affiliations

  • 1 Department of Pediatrics, CM Medical College, Durg (C.G), INDIA
  • 2 Department of Pediatrics, KKCTH, Chennai, INDIA
  • 3 Department of Community Medicine, Government Medical College, Rajnandgaon, C.G., INDIA

Int. Res. J. Medical Sci., Volume 3, Issue (3), Pages 11-15, March,28 (2015)

Abstract

Background: Acute lower respiratory illness (ALRI) contributes to significant mortality in developing countries and majority of this is secondary to hypoxemia. Early detection of hypoxemia and treatment improves outcome in these children. As pulse oximeter is not available in all health facilities in developing countries, clinical signs which predict hypoxemia should be identified. This study was done to assess the clinical predictors of hypoxemia in ALRI. A total of 204 children aged between 2-60 months, who were admitted with ALRI in emergency dept. of Kanchi Kamakoti Childs Trust Hospital (KKCTH) were studied. Clinical signs such as tachypnea, chest wall retractions, wheeze, crepitations, head nodding, cyanosis, poor feeding, grunt and impaired consciousness were recorded. Oxygen saturation of these children was recorded separately. Out of 204 children, 81 (39.7%) had hypoxemia. Of these, the prevalence of hypoxemia was noted in 57 infants (42.2%) and 24 children (34.8%) aged 12-59 months. Tachypnea had maximum sensitivity (88%).Chest wall Retractions (70%) and crepitations (73%) had fair sensitivity while specificity for these was 55% each. Signs such as poor feeding, grunt, cyanosis and head nodding had good specificity in predicting hypoxemia. None of the clinical signs of respiratory distress had all the attributes of a good predictor of hypoxemia. Clinical signs and symptoms such as chest wall retraction, inability to feed, grunting and cyanosis may be used by health workers to allow rational use of oxygen in places where there is shortage of oxygen and pulse-oximeter is not available.

References

  1. Loweski J., Mortality from acute respiratory infection in children less than 5 years of age: global estimates, World Health Stat Q, 247-252 (1986)
  2. Denny F. and Loda F.A., Acute respiratory infections are the leading cause of death in children in developing countries, Am J Trop Med Hyg, 36, 1 (1986)
  3. Duke T., Frank D. and Mgone J., Hypoxemia in children with severe pneumonia in Papua New Guinea, Int J Tuberc Lung Dis, 5, 511-19 (2000)
  4. WHO programme for the control of acute respiratory infections. Acute respiratory infections in children: case management in small hospitals in developing countries, Geneva: WHO/ARI/90.5, (1990)
  5. Onyango F.E., Steinhoff M.C., Wafula E.M., Wariua S., Musia J. and Kitonyi J., Hypoxaemia in young Kenyan children with acute lower respiratory infection, BMJ, 306 1993)
  6. Neff T.A., Routine pulse oximetry: a fifth vital sign?, Chest, 94, 227 (1998)
  7. Cherian T., John T.J., Simoes E., Steinhoff M.C. and John M., Evaluation of simple clinical signs for the diagnosis of acute lower respiratory tract infection, Lancet, i ,125-128 (1988)
  8. Shann f., Barker J. and Poore P., Clinical signs that predict death in children with severe pneumonia, Pediatric Infect Dis J, 8 ,852-855 (1989)
  9. Reuland D.S., Steinhoff M.C., Gilman R.H., Bara M., Olivares E.F. and Jabra A. et al, Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes, J Pediatr, 199, 900-907 (1991)
  10. Mulholland E.K., Olinsky A. and Shann F.A., Clinical findings and severity of acute bronchiolitis, Lancet, 335,1259-1261 (1990)
  11. Hall C.G., Hall W.J. and Speers D.M., Clinical and physiological manifestations of bronchiolitis and pneumonia. Outcome of respiratory syncytial virus, AM J Dis Child, 133, 798-802 (1979)
  12. Dyke T. and Bronw N., Hypoxia in childhood pneumonia better detection and more oxygen needed in developing countries, BMJ 308, 119-120 (1994)
  13. Duke T., Blaschke A.J., Slialis S. and Bonkowsky J.L., Hypoxemia in Acute Respiratory and non respiratory illnesses in neonates and children in a developing country, Arch Dis Child (2002)
  14. Dyke T., Lewis D., Heegaard W., Manary M., Flwe S. and Rudeen K., Predicting hypoxia in children with acute lower respiratory infection: a study in the highlands or Papua New-Guinea, J Trop Pediatr, 41, 196-201 (1995)
  15. Lozano J.M., Steinhoff M., Ruiz J.G., Meza M.L., Martinez N. and Dussan B., Clinical predictors of acute radiological pneumonia and hypoxaemia at high altitude, Arch Dis Child, 71, 323-327(1994)
  16. Usen S., Weber M. and Mullholand K. et al, Clinical predictors of hypoxaemia in Gambian children with acute lower respiratory tract infection: prospective cohort study, BMJ, 318, 86-91 (1999)
  17. Singhi S., Deep A. and Kaur H., Prevalence and predictors of hypoxeia in acute respiratory infections presenting to pediatric emergency department, IJCCM, 7(11) 118-123 (2003)
  18. Lodha R., Bhaduaria P.S., Kuttikat A.V., Puranik M., Gupta S., Pandey R.M. and Kabra S.K., Can clinical signs or symptoms accurately predict hypoxemia in children with acute lower respiratory tract infections?, India Pediatrics, 41, 129-135 (2004)
  19. WHO, Technical basis for the WHO recommendation on the management of pneumonia in children at first level health facilities Geneva, WHO/ARI/91,
  20. Seaton A., Seaton D., and Leitch A.G., Functions of the respiratory tract. Crofton and Douglasís Respiratory diseases, 4thedition Oxford, Blackwell Scientific, (1989)
  21. Weber M.W., Usen S., Palmer A., Jaffar S., and Mulholland E.K., Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country, Arch Dis Child, 76:1, (1997)
  22. Rajesh V.T., Singhi S. and Kataria S., Tachypnea is a good predictor of hypoxia in acutely ill children, Arch Dis Child, 82, 46-49 (2000)
  23. Berman S., Shanks M.B., Feiten D., Horgan J.G. and Rumack C., Acute respiratory infections during the first three months of life: clinical, radiological and physiologic predictors of etiology, Pediatr. Emerg Care, 179-182 (1990)
  24. Margolis P.A., Ferkol T.W., Marsocci S.S., Duper D.M., Keyes L.L., McNutt R. et al, Accuracy of the clinical examination in detecting hypoxemia in infants with respiratory illness, J. Pediatr., 124, 552-560 (1994)
  25. Rao Y.K. et al, Clinical predictors of hypoxemia in Indian children with acute respiratory tract infection presenting to pediatric emergency department, World j pedr., 8(3), 247-51 (2012)
  26. Basnet S., Adhikari R.K. and Gurung CK, Hypoxemia in children with pneumonia and its clinical predictors, Indian J Pediatrics 73(9), 777-781 (2006)
  27. Manisha S. and Pratibha D., Clinical and Microbiological Profile of Neonatal Infections in the Neonatal Intensive Care Unit, Int. Res. J. Medical Sci., 1(8), 15-18 (2013)