Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care.
Journal: The Lancet. Global health
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Affiliated Institutions:
Melbourne Children's Global Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia; Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria. Electronic address: hamish.graham@rch.org.au.
Department of Global Public Health, Karolinska Institute, Stockholm, Sweden.
Melbourne Children's Global Health, Murdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Melbourne, VIC, Australia.
Projahnmo Study Group, Johns Hopkins University, Dhaka, Bangladesh.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Institute for Global Health, University College London, London, UK.
Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria; Department of Paediatrics, University of Ibadan, Ibadan, Nigeria.
Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
Essential Medicines, Clinton Health Access Initiative, Kampala, Uganda.
Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Global Program in Pediatric Respiratory Sciences, Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Abstract summary
Pulse oximeters are essential for assessing blood oxygen levels in emergency departments, operating theatres, and hospital wards. However, although the role of pulse oximeters in detecting hypoxaemia and guiding oxygen therapy is widely recognised, their role in primary care settings is less clear. In this Viewpoint, we argue that pulse oximeters have a crucial role in risk-stratification in both hospital and primary care or outpatient settings. Our reanalysis of hospital and primary care data from diverse low-income and middle-income settings shows elevated risk of death for children with moderate hypoxaemia (ie, peripheral oxygen saturations [SpO] 90-93%) and severe hypoxaemia (ie, SpO <90%). We suggest that moderate hypoxaemia in the primary care setting should prompt careful clinical re-assessment, consideration of referral, and close follow-up. We provide practical guidance to better support front-line health-care workers to use pulse oximetry, including rethinking traditional binary SpO thresholds and promoting a more nuanced approach to identification and emergency treatment of the severely ill child.
Authors & Co-authors:
Graham Hamish R HR
King Carina C
Duke Trevor T
Ahmed Salahuddin S
Baqui Abdullah H AH
Colbourn Tim T
Falade Adegoke G AG
Hildenwall Helena H
Hooli Shubhada S
Kamuntu Yewande Y
Subhi Rami R
McCollum Eric D ED
Study Outcome
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