Publication:

Correlation of hypoxemia with clinical signs in children aged 2 months to 5 years with acute lower respiratory tract infection: a prospective observational study

Background Acute lower respiratory tract infection (LRTI), particularly pneumonia, is a leading cause of morbidity and mortality in children under five years of age globally. Hypoxemia is a major complication and risk factor for death in these patients. This study aimed to correlate hypoxemia with clinical signs, laboratory markers and outcomes in children with acute LRTI.

Methods A prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital Dhiraj Hospital Piparia. The study enrolled 61 children aged 2 months to 5 years diagnosed with WHO-defined community-acquired pneumonia. Clinical signs, anthropometry, laboratory parameters (CBC, CRP) and chest X-rays were recorded. Oxygen saturation (SpO2) was monitored every 6 hours. Hypoxemia was defined as SpO2 ≤ 90%. Statistical analysis was performed to determine associations between hypoxemia and clinical variables.

Results Of 61 patients, 59.02% (36/61) presented with hypoxemia. The majority were infants (75.41%) and males (73.77%). Hypoxemia was significantly associated with nasal flaring (p=0.022), chest indrawing (p=0.011) and the combination of both (p=0.001). All patients presenting with cyanosis (100%) were hypoxemic. Radiological consolidation was significantly associated with lower SpO2 (p=0.003), as were elevated total leukocyte counts (p=0.029) and C-reactive protein levels (p=0.006). Longer duration of oxygen support was required in hypoxemic patients (p=0.012). No significant association was found between hypoxemia and age, gender, nutritional status, severity of anemia or severity of pneumonia classification.

Conclusions Clinical signs such as nasal flaring, chest indrawing and cyanosis are reliable bedside predictors of hypoxemia in children with LRTI. While pulse oximetry remains the gold sta