Lozano J M
Department of Paediatrics, School of Medicine, Javeriana University, Bogota, Colombia.
Int J Tuberc Lung Dis. 2001 Jun;5(6):496-504.
To determine the prevalence of hypoxaemia in children aged under 5 years suffering acute lower respiratory infections (ALRI), the risk factors for hypoxaemia in children under 5 years of age with ALRI, and the association of hypoxaemia with an increased risk of dying in children of the same age.
Systematic review of the published literature.
Out-patient clinics, emergency departments and hospitalisation wards in 23 health centres from 10 countries.
Cohort studies reporting the frequency of hypoxaemia in children under 5 years of age with ALRI, and the association between hypoxaemia and the risk of dying.
Prevalence of hypoxaemia measured in children with ARI and relative risks for the association between the severity of illness and the frequency of hypoxaemia, and between hypoxaemia and the risk of dying.
Seventeen published studies were found that included 4,021 children under 5 with acute respiratory infections (ARI) and reported the prevalence of hypoxaemia. Out-patient children and those with a clinical diagnosis of upper ARI had a low risk of hypoxaemia (pooled estimate of 6% to 9%). The prevalence increased to 31% and to 43% in patients in emergency departments and in cases with clinical pneumonia, respectively, and it was even higher among hospitalised children (47%) and in those with radiographically confirmed pneumonia (72%). The cumulated data also suggest that hypoxaemia is more frequent in children living at high altitude. Three papers reported an association between hypoxaemia and death, with relative risks varying between 1.4 and 4.6. Papers describing predictors of hypoxaemia have focused on clinical signs for detecting hypoxaemia rather than on identifying risk factors for developing this complication.
Hypoxaemia is a common and potentially lethal complication of ALRI in children under 5, particularly among those with severe disease and those living at high altitude. Given the observed high prevalence of hypoxaemia and its likely association with increased mortality, efforts should be made to improve the detection of hypoxaemia and to provide oxygen earlier to more children with severe ALRI.
确定5岁以下患急性下呼吸道感染(ALRI)儿童的低氧血症患病率、5岁以下患ALRI儿童发生低氧血症的危险因素,以及低氧血症与同年龄儿童死亡风险增加之间的关联。
对已发表文献进行系统综述。
来自10个国家的23个健康中心的门诊、急诊科和住院病房。
报告5岁以下患ALRI儿童低氧血症发生频率以及低氧血症与死亡风险之间关联的队列研究。
测量ARI患儿的低氧血症患病率,以及疾病严重程度与低氧血症发生频率之间、低氧血症与死亡风险之间关联的相对风险。
共找到17项已发表研究,纳入了4021名5岁以下患急性呼吸道感染(ARI)的儿童,并报告了低氧血症的患病率。门诊儿童和临床诊断为上呼吸道ARI的儿童发生低氧血症的风险较低(合并估计值为6%至9%)。急诊科患者和临床诊断为肺炎的患者中,低氧血症患病率分别升至31%和43%,住院儿童(47%)和影像学确诊肺炎的儿童中患病率更高(72%)。累积数据还表明,生活在高海拔地区的儿童低氧血症更为常见。3篇论文报告了低氧血症与死亡之间的关联,相对风险在1.4至4.6之间。描述低氧血症预测因素的论文主要关注检测低氧血症的临床体征,而非识别发生该并发症的危险因素。
低氧血症是5岁以下儿童ALRI常见且可能致命的并发症,尤其是在重症患儿和生活在高海拔地区的儿童中。鉴于观察到的低氧血症高患病率及其与死亡率增加的可能关联,应努力改善低氧血症的检测,并为更多重症ALRI儿童更早地提供氧气。