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Vaticinadores clínicos de los resultados de la hipoxemia en niños menores de cinco años con diarrea, con y sin neumonía, en un hospital urbano en Dhaka, Bangladesh
Author(s) -
Chisti Mohammod J.,
Duke Trevor,
Robertson Colin F.,
Ahmed Tahmeed,
Faruque Abu S. G.,
Ashraf Hasan,
La Vincente Sophie,
Bardhan Pradip K.,
Salam Mohammed A.
Publication year - 2012
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2011.02890.x
Subject(s) - medicine , pediatrics , case fatality rate , pneumonia , confidence interval , population , malnutrition , odds ratio , logistic regression , diarrhea , prospective cohort study , sepsis , environmental health
Abstract Objective To explore the predictors and outcome of hypoxaemia in children under 5 years of age who were hospitalized for the management of diarrhoea in Dhaka, where comorbidities are common. Methods In a prospective cohort study, we enrolled all children <5 years of age admitted to the special care ward (SCW) of the Dhaka Hospital of ICDDR,B from September to December 2007. Those who presented with hypoxaemia (SpO 2 < 90%) constituted the study group, and those without hypoxaemia formed the comparison group. Results A total of 258 children were enrolled, all had diarrhoea. Of the total, 198 (77%) had pneumonia and 106 (41%) had severe malnutrition (<−3 Z ‐score of weight for age of the median of the National Centre for Health Statistics), 119 (46%) had hypoxaemia and 138 children did not have hypoxaemia at the time of admission. Children with hypoxaemia had a higher probability of a fatal outcome (21% vs. 4%; P < 0.001). Using logistic regression analysis, the independent predictors of hypoxaemia at the time of presentation were lower chest wall indrawing [OR 6.91, 95% confidence intervals (CI) 3.66–13.08, P < 0.001], nasal flaring (OR 3.22, 95% CI 1.45–7.17, P = 0.004) and severe sepsis (OR 4.48, 95% CI 1.62–12.42, P = 0.004). Conclusion In this seriously ill population of children with diarrhoea and comorbidities, hypoxaemia was associated with high case–fatality rates. Independent clinical predictors of hypoxaemia in this population, identifiable at the time of admission, were lower chest wall indrawing, nasal flaring and the clinical syndrome of severe sepsis.