Hypoxaemia and risk of death among children: rethinking oxygen saturation, risk-stratification, and the role of pulse oximetry in primary care.

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.

Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study.

Background: Retinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening.

Methods: We conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022.

Continuous Positive Airway Pressure (CPAP) for severe pneumonia in low- and middle-income countries: A systematic review of contextual factors.

Background: Continuous positive airway pressure (CPAP) may have a role in reducing the high mortality in children less than 5 years with World Health Organization (WHO) severe pneumonia. More evidence is needed to understand important contextual factors that impact on implementation, effectiveness, and safety in low resource settings.

Methods: We conducted a systematic review of Medline, Embase and Pubmed (January 2000 to August 2020) with terms of "pneumonia", "CPAP" and "child".

Technology to improve reliable access to oxygen in Western Uganda: study protocol for a phased implementation trial in neonatal and paediatric wards.

Introduction: Oxygen is an essential medicine for children and adults. The current systems for its delivery can be expensive and unreliable in settings where oxygen is most needed. FREO Foundation Australia has developed an integrated oxygen system, driven by a mains-powered oxygen concentrator, with the ability to switch automatically between low-pressure oxygen storage device and cylinder oxygen in power interruptions.

Characteristics, management and changing incidence of children with empyema in a paediatric intensive care unit.

Aim: Paediatric intensive care unit (PICU) admissions for empyema increased following the 13-valent pneumococcal conjugate vaccine (PCV13). We describe the clinical characteristics, management and outcomes for children with empyema and compare incidence before and after PCV13.

Methods: Retrospective study of patients <18 years admitted to The Royal Children's Hospital Melbourne PICU with empyema between January 2016 and July 2019.

The prevalence of hypoxemia among pediatric and adult patients presenting to healthcare facilities in low- and middle-income countries: protocol for a systematic review and meta-analysis.

Background: Hypoxemia is a severe condition associated with high rates of mortality, particularly in low- and middle-income countries (LMICs) with poor access to oxygen therapy. Despite its clinical significance, there have been few studies to describe the burden of hypoxemia. Thus, the primary objective of this study is to systematically describe the prevalence of hypoxemia among pediatric and adult patients in low- and middle-income countries.

Cause-specific neonatal morbidity and mortality in the Solomon Islands: An assessment of data from four hospitals over a three-year period.

Aim: Data on stillbirths and neonatal morbidity and mortality in low-middle income Pacific Island Nations such as Solomon Islands is limited, partly due to weak health information systems. We describe the perinatal mortality and clinical factors associated with poor newborn outcomes at four hospitals in Solomon Islands.

Methods: This was a registry based retrospective cohort study at three provincial hospitals and the National Referral Hospital (NRH) from 2014-2016 inclusive.

Reference values for oxygen saturation from sea level to the highest human habitation in the Andes in acclimatised persons.

Oxygen saturation, measured by pulse oximetry (SpO), is a vital clinical measure. Our descriptive, cross-sectional study describes SpO measurements from 6289 healthy subjects from age 1 to 80 years at 15 locations from sea level up to the highest permanent human habitation. Oxygen saturation measurements are illustrated as percentiles.

Distal intestinal obstruction syndrome in cystic fibrosis: presentation, outcome and management in a tertiary hospital (2007-2012).

Background: Cystic fibrosis (CF) can result in distal intestinal obstruction syndrome (DIOS) due to inspissated mucus. This paper describes the clinicopathological characteristics of adult CF patients with DIOS and assesses risk factors for surgery.

Methods: A retrospective audit of CF patients at the Alfred Hospital from January 2007 to February 2012 was carried out.

Global use of the WHO pocket book of hospital care for children.

Background: Studies in the last decade have identified major deficiencies in the care of seriously ill children in hospitals in developing countries. Effective implementation of clinical guidelines is an important strategy for improving quality of care. In 2005 the World Health Organization produced the Pocket Book of Hospital Care for Children - Guidelines for Management of Common Childhood Illnesses in Rural and District Hospitals with Limited Resources.

Child health nurses in the Solomon Islands: lessons for the Pacific and other developing countries.

Objectives: To understand the roles of nurses with advanced training in paediatrics in the Solomon Islands, and the importance of these roles to child health. To understand how adequately equipped child health nurses feel for these roles, to identify the training needs, difficulties and future opportunities.

Design: Semi-structured interviews.

Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis.

Objective: To review the aetiology and antibiotic resistance patterns of community-acquired sepsis in developing countries in infants where no clear focus of infection is clinically identified. To estimate the likely efficacy of WHO's recommended treatment for infant sepsis.

Design: A systematic review of the literature describing the aetiology of community-acquired neonatal and infant sepsis in developing countries.

Leadership for child health in the developing countries of the Western Pacific.

The content and landscape of global child health is increasingly complex. There is strong evidence for the effectiveness of local, national and institutional leadership in reducing child mortality, but this has not been a focus of global health initiatives. Interventions to strengthen health systems should include support for local leadership: building-up institutions of training, empowering national paediatric professional associations, creating opportunities for contribution and leadership at national, provincial and local level, and networks of support for staff working in child health in remote areas.

The Western Pacific Regional Child Survival Strategy: progress and challenges in implementation.

The Regional Child Survival Strategy (RCSS) was launched by the World Health Organization and United Nations Children's Fund in 2006. This initially involved the six highest mortality burden countries in the region (Cambodia, China, Laos PDR, Papua New Guinea, Philippines and Vietnam). This paper aimed to describe the experiences of countries in the region in adopting and implementing the RCSS, and to identify factors that promote and impede progress.

Papua New Guinea: real progress towards MDG 4 and real challenges.

With a mortality rate in the under-5 s of 93 per 1000 live births reported in the 1996 Demographic and Health Survey (DHS), Papua New Guinea (PNG) was at the time one of only four countries with stalled progress in child survival, and seemed destined to fail its national Millennium Development Goal (MDG) 4 target. However, accurate estimates have shown reductions in under-5 and infant mortality rates of 19% and 17% respectively, over 10 years from 1996 to 2006. In that period PNG adopted an integrated and coordinated approach to child health that includes all the essential interventions outlined in the Lancet's child survival series, under a framework consistent with the Western Pacific Regional Child Survival Strategy, associated with significant improvements in leadership and coordination of child health services by paediatricians at the provincial and national level.

Oxygen supplies for hospitals in Papua New Guinea: a comparison of the feasibility and cost-effectiveness of methods for different settings.

Oxygen therapy is essential in all wards, emergency departments and operating theatres of hospitals at all levels, and oxygen is life-saving. In Papua New Guinea (PNG), an effective oxygen system that improved the detection and treatment of hypoxaemia in provincial and district hospitals reduced death rates from pneumonia in children by as much as 35%. The methods for providing oxygen in PNG are reviewed.

The prevalence of hypoxaemia among ill children in developing countries: a systematic review.

Hypoxaemia is a common complication of childhood infections, particularly acute lower respiratory tract infections. In pneumonia-a disease that disproportionately impacts developing countries, and accounts for more than two million deaths of children worldwide-hypoxaemia is a recognised risk factor for death, and correlates with disease severity. Hypoxaemia also occurs in severe sepsis, meningitis, common neonatal problems, and other conditions that impair ventilation and gas exchange or increase oxygen demands.

When should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxaemia.

Background: Acute respiratory infections (ARI) cause 3 million deaths in children worldwide each year. Most of these deaths occur from pneumonia in developing countries, and hypoxaemia is the most common fatal complication. Simple and adaptable indications for oxygen therapy are important in the management of ARI.

Improved oxygen systems for childhood pneumonia: a multihospital effectiveness study in Papua New Guinea.

Background: In rural hospitals of developing countries, oxygen supplies are poor and detection of hypoxaemia is difficult. Oxygen concentrators and pulse oximeters might help to manage the disease; however, use of such technology in developing countries needs comprehensive assessment. We studied the effect of an improved oxygen system on death rate in children with pneumonia in Papua New Guinea.

Implementing an oxygen programme in hospitals in Papua New Guinea.

In Papua New Guinea (PNG), the most common cause of death among children under 5 years of age is pneumonia. Children with severe pneumonia need antibiotics and oxygen but oxygen shortages are common owing to the cost and complex logistics of transporting it in cylinders. Detection of hypoxaemia using clinical signs can be difficult, especially in highly pigmented children in whom cyanosis is difficult to recognise.