Clinical predictors of hypoxemia in children with acute lower respiratory tract infections


Background and objectives: Acute lower respiratory tract infections (ALRI) are the leading cause of morbidity and mortality among children in developing countries. Pulse oxymetry is a simple technique to determine the oxygen saturation. However, the detection of hypoxemia by use of pulse oxymetry is not available in most situations in developing countries; in addition, the availability of supplementary oxygen is inadequate. It is therefore, important to identify hypoxemia accurately in children by using of clinical signs. The objective of this study was to find out the clinical signs and symptoms that predict hypoxemia in acute lower respiratory tract infection.Methods: A well matched case control study was performed on 120 children from 2 months to 5 years of age admitted with acute lower respiratory tract infections (ALRI) to the emergency department of Raparin Pediatric Teaching Hospital -Erbil, from 1st January 2009 to 1st April 2010.Clinical symptoms and signs were recorded .Hypoxemia was defined as oxygen saturation less than 95%. A portable oxymeter was used to measure oxygen saturation with an appropriately sized sensor on the finger or the toe. The reading was taken while the child was breathing room air. The clinical symptoms and signs to predict the presence of hypoxemia were evaluated.Results: Sixty (50%) children were hypoxemic. The median O2 saturation was 91.2%with a range of 72-93.8%. Physical signs including intercostal and subtotal retractions, supraclavicular recessions, grunting, nasal flaring, cyanosis, head nodding, were statistically associated with hypoxemia.Conclusion: None of the clinical features either alone or in combinations has sufficient sensitively and specificity to predict hypoxemia in children with acute lower respiratory tract infections, therefore pulse oxymetry is desirable for identification of hypoxemia.