Hypoxaemia in children with severe pneumonia in Papua New Guinea

OBJECTIVES: To investigate the severity and duration of hypoxaemia in 703 c hildren with severe or very severe pneumonia presenting to Goroka Hospital in the Papua New Guinea highlands; to study the predictive value of clinica l signs for the severity of hypoxaemia, the predictive value of transcutane ous oxygen saturation (SpO(2)) and other variables for mortality. DESIGN: Prospective evaluation of children with severe or very severe pneum onia. SpO(2) was measured at the time of presentation and every day until h ypoxaemia resolved. Children with a SpO(2) less than 85% received supplemen tal oxygen. By comparing with a retrospective control group for whom oxygen administration was guided by clinical signs, we evaluated whether there wa s a survival advantage from using a protocol for the administration of oxyg en based on guise oximetry. We determined normal values for oxygen saturati on in children living in the highlands. RESULTS: In 151 well, normal highland children, the mean SpO(2) was 95.7% ( SD 2.7%). The median SpO(2) among children with severe or very severe pneum onia was 70% (56-77); 376 (53.5%) had moderate hypoxaemia (SpO(2) 70-84%); 202 (28.7%) had severe hypoxaemia (SpO(2) 50-69%); and 125 (17.8%) had very severe hypoxaemia (SpO(2) < 50%). Longer duration of cough or the presence of hepatomegaly or cyanosis predicted more severe degrees of hypoxaemia. A fter 10, 20 and 30 days from the beginning of treatment, respectively 102 ( 14.5%), 38 (5.4%) and 19 (2.7%) of children had persistent hypoxaemia; 46 c hildren (6.5%) died. Predictors of death were low SpO(2) on presentation, s evere malnutrition, measles and history of cough for more than 7 days. The mortality risk ratio between the 703 children managed whose oxygen administ ration was guided by the use of pulse oximetry and the retrospective contro l group who received supplemental oxygen based on clinical signs was 0.65 ( 35 % Cl 0.41-1.02, two-sided Fisher's exact test, P = 0.07). CONCLUSION: There is a need to increase the availability of supplemental ox ygen in smaller health facilities in developing countries, and to train hea lth workers to recognise the clinical signs and risk factors for hypoxaemia . In moderate sized hospitals a protocol for the administration of oxygen b ased on pulse oximetry may improve survival.