Clinical predictors and outcome of hypoxaemia among under-five diarrhoeal children with or without pneumonia in an urban hospital, Dhaka, Bangladesh

Abstract

Objective To explore the predictors and outcome of hypoxaemia in children under 5years 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 <5years 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 (SpO2<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 ( <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. © 2011 Blackwell Publishing Ltd.