TY - JOUR
T1 - Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes
AU - Reuland, D. S.
AU - Steinhoff, M. C.
AU - Gilman, R. H.
AU - Bara, M.
AU - Olivares, E. G.
AU - Jabra, A.
AU - Finkelstein, D.
N1 - Funding Information:
Acute lower respiratory tract infections of childhood are among the leading causes of morbidity and death world- Supported in part by the Bio-medicalR esearch Support Grant fund and the Bobmark Research Trust Fund. Submitted for publication March 22, 1991 ; accepted June 4, 1991. Reprint requests: R. H. Gilman, c/o M. C. Steinhoff, 624 N. Broadway, Room 125, Baltimore, MD 21205. 9/20/31489 wide, with most of the deaths occurring in developing countries, l Case management by health workers using simple clinical signs is part of the current strategy to reduce ALRI mortality rates. 2 Previous studies conducted at low altitude have shown tachypnea to be a sensitive and specific indicator of the presence of ALRI. 3-7 On the basis of these data, the World Health Organization (WHO) has revised its guidelines for management of respiratory infections by first-level health workers: presumptive antibiotic therapy
PY - 1991/12
Y1 - 1991/12
N2 - To determine the effect of respiratory infections on oxyhemoglobin saturation in a high-altitude population, we recorded clinical signs, oxyhemoglobin saturation determined by puise oximetry, and findings on radiographs of the chest of 423 children with acute respiratory infections; the children were living at an altitude of 3750 m in the Peruvian Andes. We defined hypoxemia as an oxyhemoglobin saturation value greater than 2 SD below the mean value for 153 well children in this population. Eighty-three percent of children with clinical bronchopneumonia, but only 10% of children with upper respiratory tract infection, had hypoxemia (p<0.001). Compared with previous studies of children living at lower altitudes, the presence of tachypnea was relatively nonspecific as a predictor of radiographically determined pneumonia or of hypoxemia, especially in infants. A history of rapid breathing was 74% sensitive and 64% specific in the prediction of hypoxemia, and performed as well as a standard World Health Organization case management algorithm in the prediction of radiographic pneumonia or hypoxemia. Radiographic pneumonia was not a sensitive predictor of hypoxemia or clinically severe illness. In contrast, the presence of hypoxemia was a useful predictor of radiographic pneumonia, with both sensitivity and specificity of 75% in infants. We conclude that acute lower respiratory tract infection in children living at high altitude is frequently associated with hypoxemia, and that oxygen should be administered to children with a diagnosis of pneumonia in these regions. Case management algorithms developed in low-altitude regions may have to be modified for high-altitude settings. In this setting, pulse oximetry is a good predictor of pneumonia. Because pulse oximetry is more objective and cheaper than radiography, its role as a clinical and investigative tool merits further exploration.
AB - To determine the effect of respiratory infections on oxyhemoglobin saturation in a high-altitude population, we recorded clinical signs, oxyhemoglobin saturation determined by puise oximetry, and findings on radiographs of the chest of 423 children with acute respiratory infections; the children were living at an altitude of 3750 m in the Peruvian Andes. We defined hypoxemia as an oxyhemoglobin saturation value greater than 2 SD below the mean value for 153 well children in this population. Eighty-three percent of children with clinical bronchopneumonia, but only 10% of children with upper respiratory tract infection, had hypoxemia (p<0.001). Compared with previous studies of children living at lower altitudes, the presence of tachypnea was relatively nonspecific as a predictor of radiographically determined pneumonia or of hypoxemia, especially in infants. A history of rapid breathing was 74% sensitive and 64% specific in the prediction of hypoxemia, and performed as well as a standard World Health Organization case management algorithm in the prediction of radiographic pneumonia or hypoxemia. Radiographic pneumonia was not a sensitive predictor of hypoxemia or clinically severe illness. In contrast, the presence of hypoxemia was a useful predictor of radiographic pneumonia, with both sensitivity and specificity of 75% in infants. We conclude that acute lower respiratory tract infection in children living at high altitude is frequently associated with hypoxemia, and that oxygen should be administered to children with a diagnosis of pneumonia in these regions. Case management algorithms developed in low-altitude regions may have to be modified for high-altitude settings. In this setting, pulse oximetry is a good predictor of pneumonia. Because pulse oximetry is more objective and cheaper than radiography, its role as a clinical and investigative tool merits further exploration.
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U2 - 10.1016/S0022-3476(05)83040-9
DO - 10.1016/S0022-3476(05)83040-9
M3 - Article
C2 - 1960604
AN - SCOPUS:0025720497
SN - 0022-3476
VL - 119
SP - 900
EP - 906
JO - The Journal of pediatrics
JF - The Journal of pediatrics
IS - 6
ER -