ORIGINAL ARTICLE

Hypoxaemia in acute respiratory and non-respiratory illnesses in neonates and children in a developing country

T Duke¹, A J Blaschke², S Sialis¹, J L Bonkowsky²

¹ Department of Pediatrics, Goroka Base Hospital, PO Box 392 Goroka, EHP, Papua New Guinea
² Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA

Correspondence to:
Correspondence to:
Dr T Duke, Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, 3052, Victoria, Australia;
duket{at}cryptic.rch.unimelb.edu.au

Aims: To determine, in sick neonates and children requiring admission to a hospital in the highlands of Papua New Guinea: (1) the incidence and severity of hypoxaemia; (2) the proportion with hypoxaemia who do not fulfil criteria for acute lower respiratory infection (ALRI); and (3) the power of clinical signs to predict hypoxaemia, according to age and disease category.

Methods: Age dependent normal values for transcutaneous oxygen saturation (SpO₂) were established in 218 well neonates and children in Goroka. A total of 491 sick neonates and children were then studied on presentation to the paediatric department at Goroka Hospital.

Results: A total of 257 sick neonates and children (52%) were hypoxaemic. Hypoxaemia was present in 179/245 (73%) with clinical criteria for ALRI; 79/246 (32%) with non-ALRI illnesses (including meningitis, septicaemia, severe malnutrition, low birth weight, birth asphyxia, and congenital syphilis) were also hypoxaemic. For children aged 1 month to 5 years with ALRI, the clinical signs best predicting hypoxaemia were cyanosis, respiratory rate >60, poor feeding, or reduced spontaneous activity; in those without ALRI the best predictors were cyanosis, respiratory rate >60 per minute, and inability to feed, but the positive predictive value was much lower than for children with ALRI. For neonates cyanosis was predictive of hypoxaemia, but tachypnoea or inability to feed were not.

Conclusions: Hypoxaemia is an under recognised complication of non-ALRI illnesses in children and in sick neonates in developing countries. Use of algorithms with high sensitivity for the recognition of hypoxaemia, and protocols for administration of oxygen to neonates, and to children with non-ALRI illnesses, might substantially reduce case fatality.

Keywords: hypoxaemia; respiratory illness

Abbreviations: ALRI, acute lower respiratory infection; NPV, negative predictive value; PPV, positive predictive value; ROC, receiver operating characteristic; SpO2, transcutaneous oxygen saturation; WHO, World Health Organisation

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This article has been cited by other articles:

• Subhi, R., Smith, K., Duke, T. (2009). When should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxaemia. Arch. Dis. Child. 94: 6-10 [Abstract] [Full Text]  
• Ayieko, P., English, M. (2006). In Children Aged 2-59 months with Pneumonia, Which Clinical Signs Best Predict Hypoxaemia?. J Trop Pediatr 52: 307-310 [Full Text]  
• Duke, T (2005). Neonatal pneumonia in developing countries. Arch. Dis. Child. Fetal Neonatal Ed. 90: F211-f219 [Abstract] [Full Text]  
• Duke, T, Oa, O, Mokela, D, Oswyn, G, Hwaihwanje, I, Hawap, J (2005). The management of sick young infants at primary health centres in a rural developing country. Arch. Dis. Child. 90: 200-205 [Abstract] [Full Text]  
• Duke, T (2003). Hypoxaemia in developing countries. Arch. Dis. Child. 88: 365-365 [Full Text]  
• Singhi, S, Bharti, B (2003). Response to Duke et al. Arch. Dis. Child. 88: 364-365 [Full Text]  

eLetters:

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Response to Duke et al

Sunit Singhi, et al.

ADC Online, 10 Jun 2002 [Full text]

Hypoxaemia in children: "abnormal" values may be misleading

Luis Huicho

ADC Online, 26 Nov 2002 [Full text]

Hypoxaemia in developing countries

Trevor Duke

ADC Online, 28 Nov 2002 [Full text]