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. 2019 Oct 24:16:51-63.
doi: 10.1016/j.eclinm.2019.10.009. eCollection 2019 Nov.

Hypoxaemia in hospitalised children and neonates: A prospective cohort study in Nigerian secondary-level hospitals

Hamish Graham  1   2 , Ayobami A Bakare  1 , Adejumoke I Ayede  1   3 , Oladapo B Oyewole  1 , Amy Gray  2 , David Peel  4 , Barbara McPake  5 , Eleanor Neal  2   6 , Shamim A Qazi  7 , Rasa Izadnegahdar  8 , Trevor Duke  2 , Adegoke G Falade  1   3
Affiliations

Hypoxaemia in hospitalised children and neonates: A prospective cohort study in Nigerian secondary-level hospitals

Hamish Graham et al. EClinicalMedicine. .

Abstract

Background: Hypoxaemia is a common complication of pneumonia and a major risk factor for death, but less is known about hypoxaemia in other common conditions. We evaluated the epidemiology of hypoxaemia and oxygen use in hospitalised neonates and children in Nigeria.

Methods: We conducted a prospective cohort study among neonates and children (<15 years of age) admitted to 12 secondary-level hospitals in southwest Nigeria (November 2015-November 2017) using data extracted from clinical records (documented during routine care). We report summary statistics on hypoxaemia prevalence, oxygen use, and clinical predictors of hypoxaemia. We used generalised linear mixed-models to calculate relative odds of death (hypoxaemia vs not).

Findings: Participating hospitals admitted 23,926 neonates and children during the study period. Pooled hypoxaemia prevalence was 22.2% (95%CI 21.2-23.2) for neonates and 10.2% (9.7-10.8) for children. Hypoxaemia was common among children with acute lower respiratory infection (28.0%), asthma (20.4%), meningitis/encephalitis (17.4%), malnutrition (16.3%), acute febrile encephalopathy (15.4%), sepsis (8.7%) and malaria (8.5%), and neonates with neonatal encephalopathy (33.4%), prematurity (26.6%), and sepsis (21.0%). Hypoxaemia increased the adjusted odds of death 6-fold in neonates and 7-fold in children. Clinical signs predicted hypoxaemia poorly, and their predictive ability varied across ages and conditions. Hypoxaemic children received oxygen for a median of 2-3 days, consuming ∼3500 L of oxygen per admission.

Interpretation: Hypoxaemia is common in respiratory and non-respiratory acute childhood illness and increases the risk of death substantially. Given the limitations of clinical signs, pulse oximetry is an essential tool for detecting hypoxaemia, and should be part of the routine assessment of all hospitalised neonates and children.

Keywords: Africa; Child; Hypoxaemia; Neonate; Nigeria; Oxygen; Pulse oximetry.

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Conflict of interest statement

HG, AAB, AIA, OBO, DP, EN, TD, and AGF received payment for services on this project from the funder (Bill and Melinda Gates Foundation) and RI is an employee of the funder. HG reports consultancy grants from WHO for unrelated work during the conduct of the study. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Bubble plot showing hypoxaemia prevalence on admission (y-axis), of children (<15 years of age) admitted to 12 hospitals in southwest Nigeria (November 2015 to October 2017, inclusive): by condition (labelled bubbles) and age group (x-axis). Size (area) of bubbles represent the number of affected participants. AFE = acute febrile encephalopathy; ALRI = acute lower respiratory infection; AS = asthma; D = diarrhoea; HG = haemoglobinopathy; HIV = HIV/AIDS; JN = neonatal jaundice; M = malaria; ME = meningitis/encephalitis; NE = neonatal encephalopathy; NSS = neonatal sepsis; PT/S = preterm/small; SAM = severe acute malnutrition; SS = sepsis; SZ = seizures; TY = typhoid; URTI = upper respiratory tract infection. Blue = respiratory condition; Red = other infectious condition; Yellow = non-infectious condition. Malaria, AFE, ALRI, Diarrhoeal, SAM diagnoses based on case definition, small and preterm diagnoses based on recorded birthweight and gestation, other diagnoses based on recorded admission diagnosis.
Fig. 2
Fig. 2
Predicted probability of death according to oxygen saturation, among 23,938 neonates and children in 12 secondary-level hospitals in southwest Nigeria. Predicted values based on simple logistic regression model for each age group (no adjustment for clustering or confounders). Probability of death may have been higher in the absence of oxygen therapy.
See this image and copyright information in PMC

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