Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2015 Sep 15;10(9):e0136166.
doi: 10.1371/journal.pone.0136166. eCollection 2015.

Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis

Marzia Lazzerini  1 , Michela Sonego  2 , Maria Chiara Pellegrin  3
Affiliations
Meta-Analysis

Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis

Marzia Lazzerini et al. PLoS One. .

Abstract

Objective: To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC).

Design: Systematic review and meta-analysis.

Study selection: Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC.

Data sources: Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015.

Risk of bias assessment: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias.

Results: Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude.

Conclusions: The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA 2009 Flow Diagram.
Fig 2
Fig 2. Risk of bias in the included studies.
Red = High risk of bias. Yellow = Moderate risk of bias. Green = Low risk of bias. White = Unknown risk of bias.
Fig 3
Fig 3. Association between hypoxemia and death.
Notes: seventeen studies were able to be pooled in the meta-analysis. The remaining study that could not be meta-analysed used an SpO2 cut-off of 92% and found an HR of 12.2 (95% CI 1.6–92.0).29.
Fig 4
Fig 4. Subgroup analysis in the population living at 0–1,499 meters above sea level.
Fig 5
Fig 5. Subgroup analysis in the studies with a population living at 1,500–2,500 meters above sea level.
Fig 6
Fig 6. Funnel plot to explore publication bias.
See this image and copyright information in PMC

References

    1. Nair H, Simoes EA, Rudan I, Gessner BD, Azziz-Baumgartner E, Zhang JS et al. (2013) Global and regional burden of hospital admissions for severe acute lower respiratory infections in young children in 2010: a systematic analysis. Lancet 381: 1380–90. 10.1016/S0140-6736(12)61901-1 - DOI - PMC - PubMed
    1. Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA et al. (2013) Global burden of childhood pneumonia and diarrhoea. Lancet 381: 1405–16. 10.1016/S0140-6736(13)60222-6 - DOI - PMC - PubMed
    1. Liu L, Johnson HL, Cousens S, Perin J, Scott S, Lawn JE et al. (2012) Global, regional, and national causes of child mortality: An updated systematic analysis for 2010 with time trends since 2000. Lancet 379: 2151–61. 10.1016/S0140-6736(12)60560-1 - DOI - PubMed
    1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V et al. (2012) Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2095–128. 10.1016/S0140-6736(12)61728-0 - DOI - PMC - PubMed
    1. Jackson S, Mathews KH, Pulanic D, Falconer R, Rudan I, Campbell H et al. (2013) Risk factors for severe acute lower respiratory infections in children: a systematic review and meta-analysis. Croat Med J 54: 110–21. - PMC - PubMed

MeSH terms