In-hospital mortality risk stratification in children aged under 5 years with pneumonia with or without pulse oximetry: A secondary analysis of the Pneumonia REsearch Partnership to Assess WHO REcommendations (PREPARE) dataset
Hooli, Shubhada; King, Carina; McCollum, Eric D.; Colbourn, Tim; Lufesi, Norman; Mwansambo, Charles; Gregory, Christopher J.; Thamthitiwat, Somsak; Cutland, Clare; Madhi, Shabir Ahmed; Nunes, Marta C.; Gessner, Bradford D.; Hazir, Tabish; Mathew, Joseph L.; Addo-Yobo, Emmanuel; Chisaka, Noel; Hassan, Mumtaz; Hibberd, Patricia L.; Jeena, Prakash; Lozano, Juan M.; MacLeod, William B.; Patel, Archana; Thea, Donald M.; Nguyen, Ngoc Tuong Vy; Zaman, Syed MA.; Ruvinsky, Raul O.; Lucero, Marilla; Kartasasmita, Cissy B.; Turner, Claudia; Asghar, Rai; Banajeh, Salem; Iqbal, Imran; Maulen-Radovan, Irene; Mino-Leon, Greta; Saha, Samir K.; Santosham, Mathuram; Singhi, Sunit; Awasthi, Shally; Bavdekar, Ashish; Chou, Monidarin; Nymadawa, Pagbajabyn; Pape, Jean-William; Paranhos-Baccala, Glaucia; Picot, Valentina Sanchez; Rakoto-Andrianarivelo, Mala; Rouzier, Vanessa; Russomando, Graciela; Sylla, Mariam; Vanhems, Philippe; Wang, Jianwei; Basnet, Sudha; Strand, Tor Arne; Neuman, Mark I.; Arroyo, Luis Martinez; Echavarria, Marcela; Bhatnagar, Shinjini; Wadhwa, Nitya; Lodha, Rakesh; Aneja, Satinder; Gentile, Angela; Chadha, Mandeep; Hirve, Siddhivinayak; O'Grady, Kerry-Ann F.; Clara, Alexey W.; Rees, Chris A.; Campbell, Harry; Nair, Harish; Falconer, Jennifer; Williams, Linda J.; Horne, Margaret; Qazi, Shamim A.; Nisar, Yasir Bin
Journal article, Peer reviewed
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Original versionInternational Journal of Infectious Diseases. 2023, 129, 240-250. 10.1016/j.ijid.2023.02.005
Objectives: We determined the pulse oximetry benefit in pediatric pneumonia mortality risk stratification and chest-indrawing pneumonia in-hospital mortality risk factors. Methods: We report the characteristics and in-hospital pneumonia-related mortality of children aged 2-59 months who were included in the Pneumonia Research Partnership to Assess WHO Recommendations dataset. We developed multivariable logistic regression models of chest-indrawing pneumonia to identify mortality risk factors. Results: Among 285,839 children, 164,244 (57.5%) from hospital-based studies were included. Pneumonia case fatality risk (CFR) without pulse oximetry measurement was higher than with measurement (5.8%, 95% confidence interval [CI] 5.6-5.9% vs 2.1%, 95% CI 1.9-2.4%). One in five children with chest-indrawing pneumonia was hypoxemic (19.7%, 95% CI 19.0-20.4%), and the hypoxemic CFR was 10.3% (95% CI 9.1-11.5%). Other mortality risk factors were younger age (either 2-5 months [adjusted odds ratio (aOR) 9.94, 95% CI 6.67-14.84] or 6-11 months [aOR 2.67, 95% CI 1.71-4.16]), moderate malnutrition (aOR 2.41, 95% CI 1.87-3.09), and female sex (aOR 1.82, 95% CI 1.43-2.32). Conclusion: Children with a pulse oximetry measurement had a lower CFR. Many children hospitalized with chest-indrawing pneumonia were hypoxemic and one in 10 died. Young age and moderate malnutrition were risk factors for in-hospital chest-indrawing pneumonia-related mortality. Pulse oximetry should be integrated in pneumonia hospital care for children under 5 years.