Clinical predictors of hypoxemia in 1-5 year old children with pneumonia

Made Supartha; Putu Siadi Purniti; Roni Naning; Ida Bagus Subanada

doi:10.14238/pi50.6.2010.355-60

Made Supartha Department of Child Health, Udayana Univetsity Medical School/Sanglah Hospital, Denpasar, Bali
Putu Siadi Purniti Department of Child Health, Udayana Univetsity Medical School/Sanglah Hospital, Denpasar, Bali
Roni Naning Department of Child Health, Gadjah Mada University Medical School/Dr. Sardjito Hospital, Yogyakarta, Central Java
Ida Bagus Subanada Department of Child Health, Udayana Univetsity Medical School/Sanglah Hospital, Denpasar, Bali

DOI: https://doi.org/10.14238/pi50.6.2010.355-60

Keywords: pneumonia, hypoxemia, predictor

Abstract

Background Pneumonia remains a major killer of under five children. Hypoxemia is the most serious manifestation of pneumonia. The most reliable way to detect hypoxemia is an arterial blood analysis or SPar However, these tools are not widely available; therefore, a simple clinical manifestation should be used as an alternative.

Objective To determine clinical predictors of hypoxemia in 1-5 year-old children with pneumonia in Indonesia.

Methods This study was conducted between February 2007 to Â August 2008 at Sanglah Hospital, Denpasar, Bali. Sample was selected using a convenient sampling method. Subjects were divided into group of hypoxemia and nonnal saturation. We did clinical examination and SpOz measurement, as the gold standard, simultaneously.

Results From 120 subjects" the prevalence of hypoxemia was 17.5%. The best single clinical predictors of hypoxemia was cyanosis (sensitivity 43%, specificity 99%, positive predictive value (PPV) 90%, negative predictive value (NPV) 89%). The best combination of clinical predictors of hypoxemia was cyanosis and head nodding (sensitivity 43%, specificity 99%, PPV 90%, NPV 89%.

Conclusion Cyanosis or combination of cyanosis and head nodding is useful clinical predictors of hypoxemia in childhood pneumonia.

References

1. World Health Organization. T he millennium development goals report. 200S [cited 2010 Mar 4]. Geneva: World Health Organization. Available from: http//www.undp. or.idpubsimdg2004BIIndonesiaMDG Bt GoaI4.pdf.
2. Bryce J, Boschi-Pinto C, Shibuya K, Black RE, WHO Child Health Epidemiology Reference Group. WHO estimation of the causes of death in children. Lancet. 200S;36S:1147-52.
3. UnicefIWorld Health Organization (WHO). Pneumonia: the forgotten killer of children. New York: UnicefIWorld Health Organization, 2006; p. 144.
4. Weber MW, Usen S, Palmer A, jaffar S, Mulholland EK. Predictors of hospital admissions 'With acute lower respiratory tract infection in a developing country. Arch Dis Child. 1997;76:310-4.
S. World Health Organization. Infonnal consultation on clinical use of oxygen. 2004 [cited 2005 Feb 4]. Geneva, World Health Organization. Available from: http://www.who.int/surgery/collaborations/en/Oxygen Meeting_Report Geneva2003.pdf.
6. Onyango FE, Steinhoff MC, Wafula EM, Wariua S, Mush J, Kitonyi J. Hypoxemia in young Kenyan children 'With acute lower respiratory infection. Br Med J. 1993 ;306:612-5.
7. Usen S, Weber MW, Mulholland K, Jaffar S, Oparaugo A, Omosigho C, et al. Clinical predictors of hypoxemia in Gambian children with acute lower respiratory tract infection: prospective cohort study. Br Med J. 1999;315:56-91.
8. Gunawijaya E, Widia 1M. Clinical predictors of hypoxemia in pneumonia. Paediatr Indones. 2003;43:192-5.
9. World Health Organization. Pocket book of hospital care for children: guidelines for the management of connnon illnesses with limited resources. Geneva: World Health Organization; 2005.
10. Said M. Pneumonia. In: Rahayu NN, Supriyatno B, Setyanto DB, editors. Buku ajar respirologi anak. 1st ed. Jakarta: Indonesian Pediatric Society publishing House, 200S; p. 350-65.
11. Lozano JM. Epidemiology of hypoxemia in children with acute lower respiratory infection. Int J Tuberc Lung Dis. 2001;50496-504.
12. Singhi S, Deep A, Kaur H. Prevalence and predictors of hypoxemia in acute respiratory infections presenting to pediatric emergency department. Indian J Crit Care Med. 2003;7,118-23.
13. Basnet S, Adhikari RK, Gurung CK. Hypoxemia in children 'With pneumonia and its clinical predictors. Indian J Pediatr. 2006;73 ,777-81.
14. Usen S, Weber MW. Clinical signs of hypoxemia in children 'With acute lower respiratory infection: indicators of oxygen therapy. Int j Tuberc Lung Dis. 2001;5,505-10.
I5. Wilson LM. Fungsi pernapasan nonnal. In: Wilson LM, Price SA, editors. Fisiologi prosesô€¨proses penyakit [terjemahan]. 4th ed. Michigan, Mosby Year Book Inc., 1992; p. 645-59.
16. Duke T, Mgone J, Frank D. Hypoxemia in children 'With severe pneumonia in Papua New Guinea. IntJ Tuberc Lung Dis. 2001;5:511-9.
17. 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 infections? Indian J Pediatr. 2004;41:129-3S.