CLINICAL PREDICTORS OF HYPOXEMIA IN CHILDREN WITH PNEUMONIA

A prospective study to determine which clinical factors identified chi ldren with acute lower respiratory infection who were hypoxaemic and a t risk of death was done over a 9-month period on children under 5 yea rs of age admitted to a district hospital in rural Zambia. Of 158 chil dren studied, 55 (35%) were found to be hypoxaemic and 23 (14.6%) died . For the subgroup of children under 1 year of age, a respiratory rate of >70 was the only significant predictor of hypoxaemia (p<0.001, sen sitivity 63%, specificity 89%). In older children, only the presence o f crepitations/bronchial breathing was predictive (p = 0.018, sensitiv ity 75%, specificity 57%). The likelihood of death was increased in th ose children with low oxygen saturation (p = 0.021) and poor nutrition (p = 0.007). It is concluded that, on the basis of raised respiratory rate, the WHO guidelines are likely to identify children under 1 year of age who are hypoxaemic. However, it may be necessary to include au scultatory findings in the guidelines to recognize hypoxaemia in older children in order to ensure that they receive appropriate treatment w ith oxygen. This study demonstrates that hypoxaemia and malnutrition a re risk factors for death.