Clinical predictors of hypoxic pneumonia in children from the Eastern Highlands Province, Papua New Guinea: secondary analysis of two prospective observational studies.

Autor:	Britton KJ; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.; School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia., Pomat W; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.; Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea., Sapura J; Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea., Kave J; Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea., Nivio B; Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea., Ford R; Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea., Kirarock W; Infection and Immunity Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands, Papua New Guinea., Moore HC; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.; School of Population Health, Curtin University, Perth, Western Australia, Australia., Kirkham LA; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.; Centre for Child Health Research, The University of Western Australia, Nedlands, Western Australia, Australia., Richmond PC; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.; School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia., Chan J; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia., Lehmann D; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia., Russell FM; Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.; Department of Paediatrics, Centre for International Child Health, The University of Melbourne, Melbourne, Victoria, Australia., Blyth CC; Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.; School of Medicine, The University of Western Australia, Nedlands, Western Australia, Australia.; Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.; Department of Microbiology, PathWest Laboratory Medicine, QEII Medical Centre, Nedlands, Western Australia, Australia.
Jazyk:	angličtina
Zdroj:	The Lancet regional health. Western Pacific [Lancet Reg Health West Pac] 2024 Mar 27; Vol. 45, pp. 101052. Date of Electronic Publication: 2024 Mar 27 (Print Publication: 2024).
DOI:	10.1016/j.lanwpc.2024.101052
Abstrakt:	Background: Pneumonia is the leading cause of death in young children globally and is prevalent in the Papua New Guinea highlands. We investigated clinical predictors of hypoxic pneumonia to inform local treatment guidelines in this resource-limited setting. Methods: Between 2013 and 2020, two consecutive prospective observational studies were undertaken enrolling children 0-4 years presenting with pneumonia to health-care facilities in Goroka Town, Eastern Highlands Province. Logistic regression models were developed to identify clinical predictors of hypoxic pneumonia (oxygen saturation <90% on presentation). Model performance was compared against established criteria to identify severe pneumonia. Findings: There were 2067 cases of pneumonia; hypoxaemia was detected in 36.1%. The strongest independent predictors of hypoxic pneumonia were central cyanosis on examination (adjusted odds ratio [aOR] 5.14; 95% CI 3.47-7.60), reduced breath sounds (aOR 2.92; 95% CI 2.30-3.71), and nasal flaring or grunting (aOR 2.34; 95% CI 1.62-3.38). While the model developed to predict hypoxic pneumonia outperformed established pneumonia severity criteria, it was not sensitive enough to be clinically useful at this time. Interpretation: Given signs and symptoms are unable to accurately detect hypoxia, all health care facilities should be equipped with pulse oximeters. However, for the health care worker without access to pulse oximetry, consideration of central cyanosis, reduced breath sounds, nasal flaring or grunting, age-specific tachycardia, wheezing, parent-reported drowsiness, or bronchial breathing as suggestive of hypoxaemic pneumonia, and thus severe disease, may prove useful in guiding management, hospital referral and use of oxygen therapy. Funding: Funded by Pfizer Global and the Bill & Melinda Gates Foundation. Competing Interests: Investigators are supported by National Health and Medical Research Council Investigator grants and fellowships (CCB; FMR) and Perron Trust fellowships (HCM; LAK). The studies from which data were derived were funded by Pfizer Global and the Bill & Melinda Gates Foundation. PCR has served on scientific advisory boards on behalf of his institution for Pfizer, GlaxoSmithKline, Merck and AstraZeneca outside the scope of this study. HCM has served on scientific advisory boards on behalf of her institution for Pfizer, Sanofi, and Merck outside the scope of this study. (© 2024 The Authors.)
Databáze:	MEDLINE
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