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

• Type of Material: Article
• Authors: Shubba Hooli, Baylor College of Medicine; Carina King, Karolinska Institutet; Eric D McCollum, Johns Hopkins School of Medicine; Tim Colbourn, University College London; Norman Lufesi, Ministry of Health, Lilongwe, Malawi; Charles Mwansambo, Ministry of Health, Lilongwe, Malawi; Christopher J Gregory, US Centers for Disease Control and Prevention, Fort Collins; Somsak Thamthitiwat, Thailand Ministry of Public Health–US Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand; Clare Cutland, University of Witwatersrand; Shabir A Madhi, University of Witwatersrand; Marta C Nunes, University of Witwatersrand; Bradford D Gessner, Pfizer Vaccines; Tabish Hazir, Pakistan Institute of Medical Sciences (PIMS); Joseph L Mathew, Postgrad Inst Med Educ & Res; Emmanuel Addo-Yobo, Kwame Nkrumah University Science & Technology; Noel Chisaka, World Bank, Washington DC, United States of America; Mumtaz Hassan, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan; Patricia L Hibberd, Boston University; Prakash Jeena, University of Kwazulu Natal; Juan M Lozano, Florida International University; William B MacLeod, Boston University; Archana Patel, Lata Medical Research Foundation, India; Donald M Thea, Boston University; Ngoc Tuong Vy Nguyen, Children Hosp 1; Syed MA Zaman, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Raul O Ruvinsky, Ministerio de Salud de la Nación, Buenos Aires, Argentina; Marilla Lucero, Research Institute for Tropical Medicine, Manila, Philippines; Cissy B Kartasasmita, Universitas Padjadjaran; Claudia Turner, Shoklo Malaria Research Unit; Rai Asghar, Rawalpindi Medical College; Salem Banajeh, Sana'a University; Imran Iqbal, Combined Military Hospital Institute of Medical Sciences, Multan, Pakistan; Irene Maulen-Radovan, Instituto Nacional de Pediatria Division de Investigacion Insurgentes, Mexico City, Mexico; Greta Mino-Leon, Children's Hospital Dr Francisco de Ycaza Bustamante; Samir K Saha, Child Health Research Foundation and Dhaka Shishu Hospital; Mathuram Santosham, Johns Hopkins University; Sunit Singhi, Medanta, The Medicity, Gurgaon, India; Shally Awasthi, King George's Medical University; Ashish Bavdekar, KEM Hospital Pune; Monidarin Chou, University of Health Sciences, Rodolph Mérieux Laboratory & Ministry of Environment, Phom Phen, Cambodia; Pagbajabyn Nymadawa, Mongolian Academy of Sciences; Jean-William Pape, GHESKIO, Centre GHESKIO, Port au Prince, Haiti; Glaucia Paranhos-Baccala, Fondation Merieux, Lyon, France; Valentina S Picot, Fondation Merieux, Lyon, France; Mala Rakoto-Andrianarivelo, Centre d'Infectiologie Charles Mérieux, Antananarivo, Madagascar; Vanessa Rouzier, GHESKIO, Department of Pediatrics, Port au Prince, Haiti; Graciela Russomando, Universidad Nacional de Asuncion; Mariam Sylla, Gabriel Touré Hospital; Philippe Vanhems, Hospices Civils de Lyon; Jianwei Wang, Chinese Academy of Medical Sciences & Peking Union; Sudha Basnet, University of Bergen; Tor A Strand, Innlandet Hospital Trust, Lillehammer; Mark I Neuman, Harvard Medical School; Luis Martinez Arroyo, PNUD/National University, Montevideo, Uruguay; Marcela Echavarria, Clinical Virology Unit, Centro de Educación Médica e Investigaciones Clínicas, Mar del Plata, Argentina; Shinjini Bhatnagar, Translational Health Science and Technology Institute, Faridabad, India; Nitya Wadhwa, Translational Health Science and Technology Institute, Faridabad, India; Rakesh Lodha, All India Institute of Medical Sciences, New Delhi, India; Satinder Aneja, Sharda University; Angela Gentile, R. Gutiérrez" Children's Hospital; Mandeep Chadha, ICMR National Institute of Virology; Siddhivinayak Hirv, KEM Hospital Research Center; Kerry-Ann F O'Grady, Queensland University of Technology; Alexey W Clara, Centers for Disease Control, Central American Region, Guatemala City, Guatemala; Christopher Rees, Emory University; Harry Campbell, University of Edinburgh; Harish Nair, University of Edinburgh; Jennifer Falconer, University of Edinburgh; Linda J Williams, University of Edinburgh; Margaret Horne, University of Edinburgh; Shamim A Qazi, World Health Organization, Geneva, Switzerland; Yasir Bin Nisar, World Health Organization, Geneva, Switzerland
• Language: English
• Date: 2023-03-03
• Publisher: ELSEVIER SCI LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijid.2023.02.005
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
• Volume: 129
• Start Page: 240
• End Page: 250
• Grant/Funding Information: The Bill and Melinda Gates Foundation, Seattle, WA, USA (#INV-007927).
• Keywords: Danger sign; DOUBLE-BLIND; RANDOMIZED CONTROLLED-TRIAL; PNEUMOCOCCAL CONJUGATE VACCINE; Chest indrawing; Infectious Diseases; MIDDLE-INCOME COUNTRIES; MULTICENTER; Pneumonia; Science & Technology; ILL CHILDREN; HYPOXEMIA; COMMUNITY CASE-MANAGEMENT; Child; Under 5; LOW-RESOURCE SETTINGS; ORAL AMOXICILLIN; Pulse oximetry; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

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.