Malnutrition and anaemia associated with hypoxia among hospitalized children with community-acquired pneumonia in North India

Abstract

Objectives: To assess the prevalence and explore the risk factors for hypoxia (SpO2 levels <92%) in ambient air in children hospitalized with community-acquired pneumonia (CAP). Methods: This was an observational study, conducted in a tertiary care teaching hospital in north India. Included were children aged 1 month to 5 years having pneumonia with lower chest indrawing (LCI) or severe pneumonia. Excluded were those on oxygen supplementation at time of hospitalization, patients in shock, those with cyanotic congenital heart disease and where parental consent was not obtained. World Health Organization criteria were used for assessing the severity of CAP. Anaemia and moderate malnutrition were defined as haemoglobin <10 g/dl and weight/height <−2 SD, respectively. Peripheral oxygen saturation was measured using a single, portable, battery-powered pulse oximeter at the time of admission and a cut-off of <92% was used to define hypoxia. Haemoglobin was measured by cyanmethemoglobin method. Results: From July 2013 to June 2014, 165 patients with CAP were admitted, of which 135 patients were eligible for inclusion, and of them, 74.8% (n = 101) had pneumonia with LCI and 25.2% (n = 34) had severe pneumonia. Hypoxia was found in 40% (n = 54/135) of the patients, and of them, 37% (n = 20/54) had pneumonia with LCI and 63% (n = 34/54) had severe pneumonia. Hypoxia was associated with severity of pneumonia (p value <0.001). In the unconditional logistic model, adjusted risk of hypoxia with malnutrition was 12.1 ((95% CI) 5.0–29.4, p value <0.001) and with anaemia was 4.5 ((95% CI) 1.8–11.2, p value 0.001). Conclusion: Since a substantial proportion of CAP had hypoxia at hospitalization, prompt detection at admission is essential especially in children with anaemia and malnutrition. Moreover, primary prevention of malnutrition and anaemia in children less than 5 years would contribute significantly in reducing prevalence of hypoxia and thus CAP-related mortality.