Abstract
Background: Haemoglobin desaturation, which presents as hypoxaemia, is a known phenomenon in the cycle of red blood cells sickling in sickle cell anaemia (SCA). Thus, early and accurate recognition of hypoxaemia is important in order to ameliorate its adverse effects on vital organs. This study was carried out to investigate clinical and laboratory features that predict hypoxaemia in children with SCA during steady-state.
Methods: We prospectively measured percutaneous haemoglobin saturation of 208 children with SCA in room air during steady-state at a secondary health facility in the north-west of Nigeria. Demographic, clinical and laboratory features and anthropometry were recorded. Hypoxaemia was defined as haemoglobin saturation <90%. Chi square test and logistic regression were used to assess the associations of selected factors with hypoxaemia.
Results: Participants comprised 132 males and 76 females and their age ranged from 9 to 168 months. Prevalence of hypoxaemia was 17.3%. Though hypoxaemia was significantly associated with age, time of first symptom to presentation, body mass index (BMI), weight-for-height z-score <2.0, tachycardia, chest retraction and palpable spleen, age (OR=0.78; 95% CI=0.62, 0.96), time of first symptom to presentation (OR = 1.28; 95% = 1.03, 1.59), BMI (OR = 0.87; 95% = 0.76, 0.92) and palpable spleen (OR = 2.87; 95% CI = 1.43, 16.65) remained independent predictors in the logistic regression model.
Conclusion: Careful consideration should be given to time of first symptom to presentation, body mass index and palpable spleen when evaluating children with sickle cell anaemia for hypoxaemia in resource limited settings.
Keywords: Hypoxaemia, Sickle cell anaemia, Haemoglobin saturation, Early childhood
Résumé
Contexte: La dé-saturation de l’hémoglobine, qui présente comme l’hypoxémie, est un phénomène connu dans le cycle de globules rouges drépanocytaires à l’anémie falciforme (drépanocytose). Ainsi, l’identification précoce et précise de l’hypoxémie est importante afin d’améliorer ses effets néfastes sur les organes vitaux. Cette étude a été réalisée pour étudier les caractéristiques cliniques et laboratoires qui prédisent l’hypoxémie chez les enfants atteints de drépanocytose au cours de l’état d’équilibre.
Méthodes: Nous avons prospectivement mesurés la saturation percutanée de l’hémoglobine de 208 enfants atteints de drépanocytose dans l’air de pièce pendant l’état d’équilibre dans un établissement de santé secondaires dans le nord-ouest du Nigeria. Les caractéristiques démographiques, cliniques et laboratoires ainsi que l’anthropométrie ont été enregistrées. Hypoxémie a été définie comme la saturation en hémoglobine <90%. Test de chi carré et de régression logistique ont été utilisés pour évaluer les associations de facteurs sélectionnés avec hypoxémie.
Résultats: Les participants comprenaient 132 garçons et 76 filles et leur âge variait de 9 à 168 mois. La prévalence d’hypoxémie était de 17,3%. Bien que l’hypoxémie était significativement associée avec l’âge, le temps des premiers symptômes à la présentation, indice de masse corporelle (IMC), le poids-pour-taille z-score <2,0, tachycardie, rétraction de la poitrine et la rate palpable, l’âge (OR = 0,78; IC à 95% = 0,62, 0,96), le temps des premiers symptômes à la présentation (OR = 1,28; 95% = 1,03, 1,59), l’IMC (OR = 0,87; 95% = 0,76, 0,92) et la rate palpable (OR = 2,87; IC à 95% = 1.43, 16.65) sont restés des facteurs prédictifs indépendants dans le modèle de régression logistique.
Conclusion: Une attention particulière doit être accordée aux temps des premiers symptômes à la présentation, indice de masse corporelle et la rate palpable lors de l’évaluation des enfants atteints d’anémie falciforme pour l’hypoxémie en situation de ressources limitées.
Mots-clés: hypoxémie, drépanocytose, saturation d’hémoglobine, petite enfance
Correspondence: Dr. Adebola E. Orimadegun, Institute of Child Health, College of Medicine, University of Ibadan, Nigeria. E-mail: beorimadegun@yahoo.com.
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