(672) Pediatric Lung Disease in Resource-Limited Settings: A Secondary Analysis of the Global PARITY Study

Tuesday, January 23, 2024

8:45 AM – 9:45 AM MT

Location: Connections Central - RST 10

First Author(s)

CB

Carter Biewen

n/a
San Francisco, California

Co-Author(s)

RK

Robinder Khemani, MD, MS

Associate Research Director, Professor of Pediatrics, Keck School of Medicine of USC
Children's Hospital Los Angeles
Los Angeles, California, United States
SW

Shan Ward, MD, MAS

Assistant Professor of Clinical Pediatrics, Division of Pediatric Critical Care
University of California San Francisco Medical Center, United States
Asya Agulnik, MD, MPH

Saint Jude Children's Research Hospital
Memphis, Tennessee
Srinivas Murthy, MD, MHSc

Clinical Associate Professor, Department of Pediatrics, Faculty of Medicine
University of British Columbia
Vancouver, BC, United States
Teresa B. Kortz, MD (she/her/hers)

University of California San Francicso
San Francisco, California
Kenneth Remy, MD, MSc, MSCI, FCCM

Associate Professor
Case Western Reserve University/University Hospitals Cleveland Medical Center
Avon Lake, Ohio

Introduction: Hypoxia in children causes significant global mortality. We know that Pediatric Acute Respiratory Distress Syndrome (PARDS) contributes to pediatric mortality in high-resource settings; however, few studies have evaluated PARDS in resource-limited settings (RLS) where elements of diagnostic criteria are often unavailable. To better understand mortality associated with pediatric hypoxia in RLS, we measured prevalence of PARDS risk factors (pneumonia, sepsis, drowning, aspiration, trauma, non-septic shock) and association with hospital mortality through a secondary analysis of the Global PARITY study.

Methods: Global PARITY was a multinational (20 countries, 47 sites) prospective point prevalence study of children (age 29 days to 14 years) presenting to an emergency department or directly admitted to a hospital in a self-identified RLS. Children were considered to have hypoxemia if they had oxygen saturation < 88% or required respiratory support at any time during their hospitalization. Using STATA (version 17.0), we performed descriptive statistical analyses and tests of comparison. A p-value < 0.05 was considered statistically significant.

Results: Global PARITY enrolled 7466 children of which 36% (n=2685) were admitted to the hospital or died in the emergency department. Of this group, 29.5% (n=793) experienced hypoxemia. Among children admitted with hypoxemia, 44% (n=348) were female. The median age was 23 months (IQR 7m-5y). Latin America/Caribbean had the highest rate of hypoxemia (478 patients per 1000 admissions). Of patients admitted with hypoxemia, at least one PARDS risk factor was present in 41.7% (n=331) of children. Pneumonia and sepsis were predominant risk factors, present in 33.3% (n=264) and 7.6% (n=60) of patients respectively. Those with sepsis had a 16.7% (n=10) mortality compared to 6.1% (n=45) in those without sepsis (p=0.002). All-cause mortality for patients with hypoxemia during admission was 6.9% (n=55) compared with 0.7% (n=13) in those without hypoxemia (p < 0.0001).

Conclusions: This study contributes to a growing body of pediatric literature on epidemiology and outcomes in RLS. Associations between PARDS risk factors and mortality require confirmation in further studies and can be used to stratify mortality risk in pediatric patients in resource-limited settings.