Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Morgan, Melissa C.; Maina, Beth; Waiyego, Mary; Mutinda, Catherine; Aluvaala, Jalemba; Maina, Michuki; English, Mike

doi:10.1111/jpc.13742

Cited by 8 publications

(8 citation statements)

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“…Our data show higher hypoxaemia prevalence in other conditions than most studies in the 2009 hypoxaemia review and more recent studies (malaria 8.5% versus 2.9–17.1%, meningitis 17.1 vs 2.7–14.6, malnutrition 16.3 vs 1.8–8.3, seizures 14.3 vs 11.8, diarrhoea 6.1 vs 0–4.7) [2,[8], [9], [10], [11], [12], [13], [14], [15]], but similar results to a major tertiary hospital in the same region of Nigeria [8,9]. Our data show hypoxaemia prevalence among neonates is high (22%), with similar overall rates to other studies from Africa (17–41%) [2,9,10,14,15] and particularly high prevalence among preterm neonates (27%) and those with neonatal encephalopathy (33%).…”

Section: Discussionsupporting

confidence: 42%

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

et al. 2019

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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.

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Section: Discussionsupporting

confidence: 42%

“…While hypoxaemia is less well studied in non-pneumonia cohorts, the available data suggests that hypoxaemia may be common in many non-respiratory conditions [2,[8], [9], [10], [11], [12], [13], [14], [15], [16], [17]], and that addressing oxygen access issues for these populations could deliver substantial mortality reductions [5,6].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…Conversely, some of these interventions also carry a risk of harm when administered by inadequately trained staff or without proper equipment. For example, provision of oxygen therapy in the absence of pulse oximetry monitoring increases the risk of retinopathy and subsequent visual impairment in preterm neonates [ 8 , 9 ]. Although an estimated 72% of deliveries globally occurred in facilities from 2012 to 2017 [ 10 ], lack of access to delivery and postnatal care remains a challenge in LMICs [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda

et al. 2018

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BackgroundGlobally, there were 2.7 million neonatal deaths in 2015. Significant mortality reduction could be achieved by improving care in low- and middle-income countries (LMIC), where the majority of deaths occur. Determining the physical readiness of facilities to identify and manage complications is an essential component of strategies to reduce neonatal mortality.MethodsWe developed clinical cascades for 6 common neonatal conditions then utilized these to assess 23 health facilities in Kenya and Uganda at 2 time-points in 2016 and 2017. We calculated changes in resource availability over time by facility using McNemar’s test. We estimated mean readiness and loss of readiness for the 6 conditions and 3 stages of care (identification, treatment, monitoring-modifying treatment). We estimated overall mean readiness and readiness loss across all conditions and stages. Finally, we compared readiness of facilities with a newborn special care unit (NSCU) to those without using the two-sample test of proportions.ResultsThe cascade model estimated mean readiness of 26.3–26.6% across the 3 stages for all conditions. Mean readiness ranged from 11.6% (respiratory distress-apnea) to 47.8% (essential newborn care) across both time-points. The model estimated overall mean readiness loss of 30.4–31.9%. There was mild to moderate variability in the timing of readiness loss, with the majority occurring in the identification stage. Overall mean readiness was higher among facilities with a NSCU (36.8%) compared to those without (20.0%).ConclusionThe cascade model provides a novel approach to quantitatively assess physical readiness for neonatal care. Among 23 facilities in Kenya and Uganda, we identified a consistent pattern of 30–32% readiness loss across cascades and stages. This aggregate measure could be used to monitor and compare readiness at the facility-, health system-, or national-level. Estimates of readiness and loss of readiness may help guide strategies to improve care, prioritize resources, and promote neonatal survival in LMICs.

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“…Oxygen targeting in our study was expectedly poorer than these studies, which were conducted in well-resourced settings using continuous pulse oximetry monitoring by dedicated neonatal intensive care nurses. Data from Kenya involving intermittent SpO 2 monitoring found that in the first 24 hours of life, only 6.7% of preterm/low birthweight neonates remained consistently within the target SpO 2 range, and more than half (53%) had more SpO 2 readings outside the target range than within 29…”

Section: Discussionmentioning

confidence: 99%

“…Data from Kenya involving intermittent SpO 2 monitoring found that in the first 24 hours of life, only 6.7% of preterm/low birthweight neonates remained consistently within the target SpO 2 range, and more than half (53%) had more SpO 2 readings outside the target range than within. 29 …”

Section: Discussionmentioning

confidence: 99%

Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context

Walker

Bakare

Ayede

et al. 2019

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting.Design and settingProspective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO2 monitoring.PatientsWe recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period.Main outcome measuresProportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO2 range of 90%–95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%–100%.ResultsPreterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO2 range of 90%–95%. They spent 75.0% (63.6–81.1) of time above 95%, and 2.7% (1.7–5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%–100%, and 0.9% (0.3–1.4) of time below 85%. Guidelines recommended SpO2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively.ConclusionsTo better maintain SpO2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO2 5.3 times per day appears suitable.

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Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Cited by 8 publications

References 44 publications

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

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

Clinical cascades as a novel way to assess physical readiness of facilities for the care of small and sick neonates in Kenya and Uganda

Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context

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