• F E Onyango, M C Steinhoff, E M Wafula, S Wariua, J Musia, and J Kitonyi.
• Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Kenya.
• BMJ. 1993 Mar 6;306(6878):612-5.

ObjectivesTo determine the prevalence, clinical correlates, and outcome of hypoxaemia in acutely ill children with respiratory symptoms.DesignProspective observational study.SettingPaediatric casualty ward of a referral hospital at 1670 m altitude in Nairobi, Kenya.Subjects256 Infants and children under 3 years of age with symptoms of respiratory infection.Main Outcome MeasuresPrevalence of hypoxaemia, defined as arterial oxygen saturation < 90% determined by pulse oximetry, and condition of patient on the fifth day after admission.ResultsOver half (151) of the children were hypoxaemic, and short term mortality was 4.3 times greater in these children. In contrast, the relative risk of a fatal outcome in children with radiographic pneumonia was only 1.03 times that of children without radiographic pneumonia. A logistic regression model showed that in 3-11 month old infants a respiratory rate > or = 70/min, grunting, and retractions were the best independent clinical signs for the prediction of hypoxaemia. In the older children a respiratory rate of > or = 60/min was the single best clinical predictor of hypoxaemia. The presence of hypoxaemia predicted radiographic pneumonia with a sensitivity of 71% and specificity of 55%.ConclusionsOver half the children presenting to this referral hospital with respiratory symptoms were hypoxaemic. A group of specific clinical signs seem useful in predicting hypoxaemia. The clear association of hypoxaemia with mortality suggests that the detection and effective treatment of hypoxaemia are important aspects of the clinical management of acute infections of the lower respiratory tract in children in hospital in developing regions.

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