Prevalence and predictors of hypoxaemia in hospitalised children at the emergency unit of a resource constrained cen

Abstract

Background: Hypoxaemia is often poorly detected and treated in emergently-ill children in resource-poor centres because of the non-availability of pulse oximeters and similar facilities to detect it. This study sets out to determine the prevalence and simple predictors of hypoxaemia among children with or without respiratory features at the emergency unit of the Wesley Guild Hospital, Ilesa, Nigeria

Methods: Children aged one month to 14 years were consecutively recruited and prospectively studied over an eight month period. All the children had their peripheral oxygen saturation (SpO₂) measured at presentation using a portable pulse oximeter (Nellcor^(R) N-200, USA) and hypoxaemia was defined as SpO₂ < 90%. Relevant history and examination findings were compared among hypoxaemic and nonhypoxaemic children. Multivariate analysis was used to predict the presence of hypoxaemia.

Results: Four hundred and two children were recruited with male to female ratio of 1.3:1 and105 (26.1) presented with respiratory features. Eighty three (20.6%) were hypoxaemic including 40 (38.1%) of those with respiratory features at admission. Infancy, chest in-drawing, cyanosis and grunting were associated with hypoxaemia (p < 0.05) among those with respiratory features, while infancy, pallor and tachycardia were significant among those with no respiratory features. Grunting (OR = 7.875; 95% CI=1.029- 15.797; p = 0.045) and Cyanosis (OR =13.579; 95% CI = 1.360- 14.379; p = 0.009) independently predict hypoxaemia among the children with respiratory features.

Conclusion: Hypoxaemia occurred in approximately one out of five ill children admitted to the emergency unit of the WGH, Ilesa and was significantly associated with mortality. Emergently ill children with cyanosis and grunting especially infants should preferentially be placed on oxygen therapy even when hypoxaemia cannot be confirmed.

Keywords: Emergently ill children, hypoxaemia, predictors, resource- poor