PREVALENCE OF HYPOXAEMIA IN PAEDIATRIC PATIENTS ATTENDING CHILDREN OUT PATIENT CLINIC

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Alex-Hart BA, Yaguo Ide LE*, “PREVALENCE OF HYPOXAEMIA IN PAEDIATRIC PATIENTS ATTENDING CHILDREN OUT PATIENT CLINIC”, ijmhs, vol. 9, no. 12, pp. 709–716, Dec. 2019.
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Abstract

Background; In more developed countries, it is a common practice to use
pulse oximetry for the diagnosis of hypoxaemia, regrettably, it is not so in
resource limited environments like ours especially in outpatient settings while
carrying out emergency triage assessment. Aim; The aim of this study was to
determine the prevalence of undictated hypoxaemia among children presenting
to the children outpatient clinic of the department of paediatrics at the
University of Port Harcourt teaching hospital. Methods; This descriptive
cross-sectional study of the prevalence of hypoxemia was conducted at the
children outpatient clinic of the department of paediatrics at the University of
Port Harcourt teaching hospital. The room air oxygen saturations of paediatric
outpatients were measured at rest from May, 2019 to September, 2019 using
digital pulse oximetry. Hypoxaemia was defined as SpO2 less than 90% in
room air at rest. Results; A total of 351 children were recruited for the study of
which 201 (57.3%) were males and 150 (42.7%) were females giving a Male:
Female ratio of 1.34:1, 233(66.38%) were under-fives. Prevalence of
hypoxaemia was 40(11.4%). Acute respiratory infection (ARI) was the
commonest condition presenting to the children outpatient clinic in 119(33.9%)
and it was also the condition with the highest prevalence of hypoxia 11
(27.5%) of all the cases with hypoxia followed by malaria 4(10%) and
diarrhoea 4(10%) Oximetry finding enabled patient to be seen faster
( accelerating triaging) and sent to the children emergency room for oxygen
therapy amidst other treatments. In conclusions, there is a high prevalence of
hypoxemia among children presenting at the outpatient clinic of the department
of paediatrics at the University of Port Harcourt teaching hospital. There
should be routine screening for hypoxaemia during emergency triage and
assessment by the outpatient clinic nurses. Pulse oximeter should be made
available to the outpatient clinic nurses by the hospital to enable them routinely
screen for hypoxaemia and prioritize the patients with hypoxaemia among
patients to be quickly seen by paediatricians and oxygen therapy commenced
to reduce morbidity and mortality from hypoxaemia.
Key words: Hypoxia Paediatrics Prevalence Children Pulse Oximetry Oxygen

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References

1.Black RE, Cousens S, Johnson HL, et al.Global, regional, and national causes ofchild mortality in 2008: a systematicanalysis. Lancet. 375 (2010)1969–87.[PubMed: 20466419] 2.Subhi R, Adamson M, Campbell H, et al.The prevalence of hypoxaemia among illchildren in developing countries: asystematic review. Lancet Infect Dis.92(2009)219–27. [PubMed: 19324294] 3.WHO. Integrated Management ofChildhood Illness (IMCI): Managementof a Child With Serious Infection orSevere Malnutrition. Geneva: WorldHealth Organization; 2000. WHO/FCH/CAH/ 00.1 4.WHO. Emergency Triage Assessmentand Treatment (ETAT): Manual forParticipants. Geneva: World HealthOrganization; 2005. 5.Duke T, Frank D, Mjone J, Hypoxaemiain children with pneumonia in PaupaNew guinea, Int. J. Tuberc. Dis.5(2000)511-519 6.Weber MW, Mulholland EK. Pulseoximetry in developing countries. Lancet.351(1998)1589. [PubMed: 10326572] 7.McMorrow RC, Mythen MG Pulseoximetry. Curr Opin Crit Care 12(3)(2006)269–271 8.Moller JT, Pedersen T, Rasmussen LS etal Randomized evaluation of pulseoximetry in 20,802 patients: I. Design,demography, pulse oximetry failure rate,and overall complication rate.Anesthesiology 78(3) (1993)436–444 9.Mower WR, Myers G, Nicklin EL,Kearin KT, Baraff LJ, Sachs C Pulseoximetry as a fifth vital sign inemergency geriatric assessment. AcadEmerg Med 5(9)(1998) 858–865 10.Mower WR, Sachs C, Nicklin EL, BaraffLJ Pulse oximetry as a fifth pediatricvital sign. Pediatrics 99(5) (1997)681–686 11.Matai S, Peel D, Wandi F, Jonathan M,Subhi R, Duke T Implementing anoxygen programme in hospitals in PapuaNew Guinea. Ann Trop Paediatr28(1)7(2008) 1–78 12.Duke T, Wandi F, Jonathan M et alImproved oxygen systems for childhoodpneumonia: a multihospital effectivenessstudy in Papua New Guinea. Lancet372(9646) (2008) 1328–1333 13.Mwaniki MK, Nokes DJ, Ignas J et alEmergency triage assessment forhypoxaemia in neonates and youngchildren in a Kenyan hospital: anobservational study. Bull World HealthOrgan 87(4)(2009) 263–270 14.Choi J, Claudius I Decrease inemergency department length of stay as a result of triage pulse oximetry. Pediatr Emerg Care 22(6) (2006) 412–414 15.Okoh B A, Jaja P,Hypoxaemia inNigerian children presenting to CHEW ofa tertiary hospital. Asian journal ofPaediatric Reasearch. 2(2019)1-6 16.Wandi F, Peel D, Duke T Hypoxaemiaamong children in rural hospitals inPapua New Guinea: epidemiology andresource availability–a study to support anational oxygen programme. Ann TropPaediatr 26(4) (2006) 277–284 17.Junge S, Palmer A, Greenwood BM, KimMulholland E, Weber MW The spectrumof hypoxaemia in children admitted tohospital in The Gambia, West Africa.Trop Med Int Health 11 (3) (2006) 367–372 18.Maitland K, Levin M, English M et alSevere P. falciparum malaria in Kenyanchildren: evidence for hypovolaemia.QJM 96 (6) (2003) 427–434 19.Ibrahim R.M, Johnson W.B, AbdulkarimA.A Hypoxaemia in under-five Nigerianchildren in hospital with pneumonia.West African J Med 33(1)2014, 37-43 20.Foran M, Ahn R, Novik J, Tyer-Viola L,Chilufya K, Katamba K, Burke T.Prevalence of undiagnosed hypoxaemiain adults and children in an under-resourced district in Zambia. Int J EmergMed 3 (2010) 351-356. 21.McCollum ED, Bjornstad E, Preidis GA,Hosseinipour MC, Lufesi N. Multicenterstudy of hypoxaemia prevalence andquality of oxygen treatment forhospitalized Malawian children. Trans RSoc Trop Med Hyg 2013; 107 (5): 285-292. 22.Onyango FE, Steinhoff MC, Wafula EM,Wariua S, Musia J, Kitonyi J.Hypoxaemia in Kenyan children withlower respiratory infection. BMJ 1993;306: 612-615. 23.Basnet S, Adhikari RK, Gurung CK.Hypoxaemia in children with pneumoniaand its clinical predictors. Indian Journalof Paediatrics 2006; 73: 777-781. 24.Salah ET, Algasim SH, Mhamoud AS,Husain NEOSA. Prevalenceof hypoxaemia in under-fivewith pneumonia in an emergency Paediatricshospital in Sudan. Indian J Crit Med2015; 19 (4): 203-207. 25.Kuti BP, Adegoke SA, Ebruke BE,Howie S, Oyelami OA, Ota M.Determinants of oxygen therapy inchildhood pneumonia in a resource-constrained region. ISRN Paediatrics2013; Article ID 435976:6. Available athttp://downloads.hindawi.com/archive/2013/435976.pdf. Accessed 10th November2019. 26.De Graaff JC, Bijker JB, Kappen TH,Wolfswinkel VL, Zuithoff NP, KalkmanCJ. Incidence of intraoperativehypoxaemia in children in relation to age.Anesth Analg 2013;117 (1): 169-175. 27.World Health Organisation (WHO).World Health Organisation programmefor the control of acute respiratoryinfections. Acute respiratory infections inchildren: case management in smallhospitals in developing countries.Geneva: WHO/ARI/90.5,1990 28.Usen S, Weber M, Mulholland K, JaffarS, Oparaugo A, Omosigho C, AdegbolaR, Greenwood B. Clinical predictors ofhypoxaemia in Gambian children withacute lower respiratory tract infection:Prospective cohort study. BMJ 1999; 318(7176): 86-91 29.World Health Organisation (WHO).Children: Reducing mortality. Availableat https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality.Accessed 12th

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References

1.Black RE, Cousens S, Johnson HL, et al.Global, regional, and national causes ofchild mortality in 2008: a systematicanalysis. Lancet. 375 (2010)1969–87.[PubMed: 20466419]
2.Subhi R, Adamson M, Campbell H, et al.The prevalence of hypoxaemia among illchildren in developing countries: asystematic review. Lancet Infect Dis.92(2009)219–27. [PubMed: 19324294]
3.WHO. Integrated Management ofChildhood Illness (IMCI): Managementof a Child With Serious Infection orSevere Malnutrition. Geneva: WorldHealth Organization; 2000. WHO/FCH/CAH/ 00.1
4.WHO. Emergency Triage Assessmentand Treatment (ETAT): Manual forParticipants. Geneva: World HealthOrganization; 2005.
5.Duke T, Frank D, Mjone J, Hypoxaemiain children with pneumonia in PaupaNew guinea, Int. J. Tuberc. Dis.5(2000)511-519
6.Weber MW, Mulholland EK. Pulseoximetry in developing countries. Lancet.351(1998)1589. [PubMed: 10326572]
7.McMorrow RC, Mythen MG Pulseoximetry. Curr Opin Crit Care 12(3)(2006)269–271
8.Moller JT, Pedersen T, Rasmussen LS etal Randomized evaluation of pulseoximetry in 20,802 patients: I. Design,demography, pulse oximetry failure rate,and overall complication rate.Anesthesiology 78(3) (1993)436–444
9.Mower WR, Myers G, Nicklin EL,Kearin KT, Baraff LJ, Sachs C Pulseoximetry as a fifth vital sign inemergency geriatric assessment. AcadEmerg Med 5(9)(1998) 858–865
10.Mower WR, Sachs C, Nicklin EL, BaraffLJ Pulse oximetry as a fifth pediatricvital sign. Pediatrics 99(5) (1997)681–686
11.Matai S, Peel D, Wandi F, Jonathan M,Subhi R, Duke T Implementing anoxygen programme in hospitals in PapuaNew Guinea. Ann Trop Paediatr28(1)7(2008) 1–78
12.Duke T, Wandi F, Jonathan M et alImproved oxygen systems for childhoodpneumonia: a multihospital effectivenessstudy in Papua New Guinea. Lancet372(9646) (2008) 1328–1333
13.Mwaniki MK, Nokes DJ, Ignas J et alEmergency triage assessment forhypoxaemia in neonates and youngchildren in a Kenyan hospital: anobservational study. Bull World HealthOrgan 87(4)(2009) 263–270
14.Choi J, Claudius I Decrease inemergency department length of stay as a result of triage pulse oximetry. Pediatr Emerg Care 22(6) (2006) 412–414
15.Okoh B A, Jaja P,Hypoxaemia inNigerian children presenting to CHEW ofa tertiary hospital. Asian journal ofPaediatric Reasearch. 2(2019)1-6
16.Wandi F, Peel D, Duke T Hypoxaemiaamong children in rural hospitals inPapua New Guinea: epidemiology andresource availability–a study to support anational oxygen programme. Ann TropPaediatr 26(4) (2006) 277–284
17.Junge S, Palmer A, Greenwood BM, KimMulholland E, Weber MW The spectrumof hypoxaemia in children admitted tohospital in The Gambia, West Africa.Trop Med Int Health 11 (3) (2006) 367–372
18.Maitland K, Levin M, English M et alSevere P. falciparum malaria in Kenyanchildren: evidence for hypovolaemia.QJM 96 (6) (2003) 427–434
19.Ibrahim R.M, Johnson W.B, AbdulkarimA.A Hypoxaemia in under-five Nigerianchildren in hospital with pneumonia.West African J Med 33(1)2014, 37-43
20.Foran M, Ahn R, Novik J, Tyer-Viola L,Chilufya K, Katamba K, Burke T.Prevalence of undiagnosed hypoxaemiain adults and children in an under-resourced district in Zambia. Int J EmergMed 3 (2010) 351-356.
21.McCollum ED, Bjornstad E, Preidis GA,Hosseinipour MC, Lufesi N. Multicenterstudy of hypoxaemia prevalence andquality of oxygen treatment forhospitalized Malawian children. Trans RSoc Trop Med Hyg 2013; 107 (5): 285-292.
22.Onyango FE, Steinhoff MC, Wafula EM,Wariua S, Musia J, Kitonyi J.Hypoxaemia in Kenyan children withlower respiratory infection. BMJ 1993;306: 612-615.
23.Basnet S, Adhikari RK, Gurung CK.Hypoxaemia in children with pneumoniaand its clinical predictors. Indian Journalof Paediatrics 2006; 73: 777-781.
24.Salah ET, Algasim SH, Mhamoud AS,Husain NEOSA. Prevalenceof hypoxaemia in under-fivewith pneumonia in an emergency Paediatricshospital in Sudan. Indian J Crit Med2015; 19 (4): 203-207.
25.Kuti BP, Adegoke SA, Ebruke BE,Howie S, Oyelami OA, Ota M.Determinants of oxygen therapy inchildhood pneumonia in a resource-constrained region. ISRN Paediatrics2013; Article ID 435976:6. Available athttp://downloads.hindawi.com/archive/2013/435976.pdf. Accessed 10th November2019.
26.De Graaff JC, Bijker JB, Kappen TH,Wolfswinkel VL, Zuithoff NP, KalkmanCJ. Incidence of intraoperativehypoxaemia in children in relation to age.Anesth Analg 2013;117 (1): 169-175.
27.World Health Organisation (WHO).World Health Organisation programmefor the control of acute respiratoryinfections. Acute respiratory infections inchildren: case management in smallhospitals in developing countries.Geneva: WHO/ARI/90.5,1990
28.Usen S, Weber M, Mulholland K, JaffarS, Oparaugo A, Omosigho C, AdegbolaR, Greenwood B. Clinical predictors ofhypoxaemia in Gambian children withacute lower respiratory tract infection:Prospective cohort study. BMJ 1999; 318(7176): 86-91
29.World Health Organisation (WHO).Children: Reducing mortality. Availableat https://www.who.int/news-room/fact-sheets/detail/children-reducing-mortality.Accessed 12th

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