Hypoxia in childhood pneumonia: better detection and more oxygen needed in developing countries
Dyke, T.; Brown, N.
Bmj 308(6921): 119-120
1994
ISSN/ISBN: 0959-8138 PMID: 8298386 Document Number: 291443
Acute respiratory infection (ARI) is responsible for many childhood deaths in developing countries, particularly deaths of children less than six months old. A major risk factor for death in children with ARI is hypoxia, which is oxygen saturation of 90% in the blood, but administration of oxygen is rare and, when it is administered, clinicians tend to use it when the children become so severely ill that their outcome is poor. Oxygen is not readily available in developing countries. Administration of oxygen earlier in the course of ARI may improve outcome and prevent deterioration. In Papua New Guinea, standard treatment manuals list indications for oxygen use as cardiac failure, grunting, drowsiness, and apneic episodes, in addition to cyanosis and restlessness. Indications that significantly increase diagnosis of hypoxemia and therefore the need for oxygen, although they are not clear cut, include either cyanosis or grunting together with an increased respiratory rate. Use of pulse oximeters would facilitate decisions to use oxygen, but they are cost-prohibitive for developing countries, except in a few well-equipped health facilities. A pragmatic approach to making a decision on what child receives oxygen is administration of a test dose and monitoring the child's response after 24 hours of oxygen therapy. If the child's condition improves, oxygen treatment should continue. Rational criteria are needed to facilitate the decision to stop giving oxygen to a child who does not respond, however. Oxygen concentrators may improve management of childhood pneumonia in developing countries and would be more cost-effective than conventional bottled oxygen. Yet, oxygen concentrators depend on a reliable electricity source. Providers should use an intranasal catheter to administer oxygen to children with pneumonia, since it is less wasteful (50% oxygen concentration at low rate of 0.5 l/min) and safer should the tube disconnect.