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

Abstract

a b s t r a c tBackground: 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.

Oxygen systems to improve clinical care and outcomes for children and neonates: A stepped-wedge cluster-randomised trial in Nigeria

“…The project was implemented with the support of the Gates Foundation, World Health Organization (WHO), and federal and state health agencies. Earlier findings have been published elsewhere [6, 27–29].…”

“…Our study was part of a pragmatic field trial to better inform efforts to improve oxygen access to children and newborns in Nigeria and other LMICs. We have reported results from our needs assessment and hypoxaemia prevalence estimates previously, showing that hypoxaemia is common in both respiratory and nonrespiratory childhood illnesses and that many hospitals have limited access to pulse oximetry and oxygen therapy [6, 29].…”

“…Oxygen is an essential medical therapy that is important in resuscitation, medical, surgical, and obstetric care [1]. Oxygen therapy is particularly important for acutely unwell children and neonates, as hypoxaemia affects approximately one in five neonates and one in 10 children who are admitted to hospital [2] and increases their risk of death approximately 6-fold [3–6].…”

“…The conditions responsible for the largest number of child deaths in Nigeria are pneumonia (18%), malaria (14%), complications of prematurity (12%), neonatal encephalopathy and trauma (11%), diarrhoeal diseases (10%), and neonatal sepsis (5%) [18]. Data from sub-Saharan Africa suggest that hypoxaemia affects approximately 14% of children and neonates admitted to hospital, including 28%–49% of children with pneumonia, 8%–30% of children with malaria, and 22%–41% of neonates [2, 3, 6, 19–26].…”

Efficacy and safety of oxygen-sparing nasal reservoir cannula for treatment of pediatric hypoxemic pneumonia in Uganda: a pilot randomized clinical trial

“…Pneumonia is the leading cause of death among children under 5 years old globally [ 1 , 2 ], accounting for 15% of all childhood deaths [ 3 ]. Hypoxemia is a potentially fatal complication of pneumonia, and the risk of death increases with increasing severity of hypoxemia [ 2 , 4 – 6 ].…”