Hamish Graham1,2, Ayobami A Bakare1, Adejumoke I Ayede1,3, Oladapo B Oyewole1, Amy Gray2, David Peel4, Barbara McPake5, Eleanor Neal2,6, Shamim A Qazi7, Rasa Izadnegahdar8, Trevor Duke2, Adegoke G Falade1,3. 1. Department of Paediatrics, University College Hospital, Ibadan, Nigeria. 2. Centre for International Child Health, University of Melbourne, MCRI, Royal Children's Hospital, Parkville, Australia. 3. Department of Paediatrics, University of Ibadan, Ibadan, Nigeria. 4. Ashdown Consultants, Hartfield, England. 5. Nossal Institute of Global Health, University of Melbourne, Parkville, Australia. 6. Pneumococcal Research, MCRI, Royal Children's Hospital, Parkville, Australia. 7. Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland. 8. Bill and Melinda Gates Foundation, Seattle, USA.
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.
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.
Authors: José Villar; Francesca Giuliani; Tanis R Fenton; Eric O Ohuma; Leila Cheikh Ismail; Stephen H Kennedy Journal: Lancet Date: 2016-02-18 Impact factor: 79.321
Authors: Quique Bassat; Miguel Lanaspa; Sónia Machevo; Cristina O'Callaghan-Gordo; Lola Madrid; Tacilta Nhampossa; Sozinho Acácio; Anna Roca; Pedro L Alonso Journal: Trop Med Int Health Date: 2016-07-11 Impact factor: 2.622
Authors: T Duke; S M Graham; M N Cherian; A S Ginsburg; M English; S Howie; D Peel; P M Enarson; I H Wilson; W Were Journal: Int J Tuberc Lung Dis Date: 2010-11 Impact factor: 2.373
Authors: Calum Davey; James Hargreaves; Jennifer A Thompson; Andrew J Copas; Emma Beard; James J Lewis; Katherine L Fielding Journal: Trials Date: 2015-08-17 Impact factor: 2.279
Authors: Hamish Graham; Shidan Tosif; Amy Gray; Shamim Qazi; Harry Campbell; David Peel; Barbara McPake; Trevor Duke Journal: Bull World Health Organ Date: 2017-02-21 Impact factor: 9.408
Authors: Hamish R Graham; Ayobami A Bakare; Amy Gray; Adejumoke Idowu Ayede; Shamim Qazi; Barbara McPake; Rasa Izadnegahdar; Trevor Duke; Adegoke G Falade Journal: BMJ Glob Health Date: 2018-06-26
Authors: Ahmed Ehsanur Rahman; Aniqa Tasnim Hossain; Mohammod Jobayer Chisti; David H Dockrell; Harish Nair; Shams El Arifeen; Harry Campbell Journal: J Glob Health Date: 2021-09-11 Impact factor: 4.413
Authors: Hamish R Graham; Jaclyn Maher; Ayobami A Bakare; Cattram D Nguyen; Adejumoke I Ayede; Oladapo B Oyewole; Amy Gray; Rasa Izadnegahdar; Trevor Duke; Adegoke G Falade Journal: PLoS One Date: 2021-07-08 Impact factor: 3.240
Authors: Jerry Mulondo; Stella Maleni; Hellen Aanyu-Tukamuhebwa; Ezekiel Mupere; Alfred Onubia Andama; Chin Hei Ng; Stephen Burkot; Ella M E Forgie; Qaasim Mian; Christine M Bachman; Gerard Rummery; Daniel Lieberman; David Bell; Michael T Hawkes; Akos Somoskovi Journal: BMC Pulm Med Date: 2020-08-31 Impact factor: 3.317
Authors: Melissa M Medvedev; Helen Brotherton; Abdou Gai; Cally Tann; Christopher Gale; Peter Waiswa; Diana Elbourne; Joy E Lawn; Elizabeth Allen Journal: Lancet Child Adolesc Health Date: 2020-02-28