Benefits and risks Antibiotics use in the management of severe acute malnutrition
10. Evidence for recommendations on the oxygen use and delivery
10.1 Pulse oximetry for detection of hypoxaemia
1. Pulse oximetry is recommended to determine the presence of hypoxaemia and to guide administration of oxygen therapy in all infants and children with hypoxaemia. Strong recommendation, low quality evidence he panel noted that although there are no studies comparing arterial blood gases versus pulse oximetry in children, the meta-analysis in adults shows a very high correlation. Pulse oximetry is non-invasive, feasible to implement, and does not require any special skills. It is, therefore, more suitable for use more widely.10.1.1 Evidence and summary of findings
A systematic review of the accuracy of pulse oximetry in children was not found. A meta-analysis of 74 studies of adult subjects, published between 1976-1994, reported the correlation between pulse oximetry measurements and arterial blood gas ABG analysis, and investigated how a number of factors afected this relationship [Jensen, 1998] see GRADE table A7.28 . he available low quality evidence shows that pulse oximetry is the best non-invasive method of detecting hypoxaemia, and should be made globally available. Subjects included in the studies were healthy adult volunteers 25.7, respiratory patients 20.3, cardiac and thoracic surgical patients 18.9, critically ill patients 16.2, and athletes 5.4. Of 39 studies that reported suicient data on the number of subjects and data points to calculate the correlation coeicient r between pulse oximetry and ABG, the weighted mean r was 0.895 +- 0.014. his estimate did not signiicantly change when only higher quality studies were considered r = 0.883. he highest correlation was in healthy volunteers r = 0.957, and the lowest in critically ill patients r = 0.760. he accuracy of oximeters difered depending on the oximeter make, particularly at saturations below 70. Finger probes were found to have a signiicantly higher correlation with SaO 2 than ear probes p 0.0001. he correlation coeicient in ive studies of hypoxic subjects SaO 2 67.6 -87.8 was high r = 0.938. Factors that reduced accuracy included dyshemoglobinemia, hypothermia, and skin pigmentation.Parts
» Hospital Care WHO evidence 0
» Objectives of the recommendations
» Management of conflict of interest
» Defining the scope Methodology and process
» Evidence retrieval and synthesis process
» Consensus building and external peer review
» Review and update of the recommendations
» Proposed subsidiary products Implementation of the recommendations
» Implementation of the recommendations
» National adaptation and implementation
» Management of neonatal jaundice Empirical antibiotics for suspected neonatal sepsis
» Antibiotic treatment for non-severe pneumonia with no wheeze
» Inhaled salbutamol for treatment of acute wheezeasthma and
» Antibiotics for treatment of acute otitis media
» Clinical signs for detection of hypoxaemia in children
» Oxygen delivery methods Criteria for starting and stopping oxygen therapy
» Evidence and summary of findings
» Benefits and risks Acceptability and feasibility
» Evidence and summary of findings Benefits and risks
» Acceptability and feasibility Management of neonatal jaundice
» Benefits and risks Head or whole body cooling in management of hypoxic ischaemic
» Acceptability and feasibility Head or whole body cooling in management of hypoxic ischaemic
» Evidence and summary of recommendations
» Acceptability and feasibility Kangaroo Mother Care
» Benefits and risks Prevention of hypothermia immediately after birth in low birth
» Acceptability and feasibility Prevention of hypothermia immediately after birth in low birth
» Benefits and risks Antibiotic treatment for non-severe pneumonia with wheeze
» Acceptability and feasibility Antibiotic treatment for non-severe pneumonia with wheeze
» Benefits and risks Antibiotic treatment for non-severe pneumonia with no wheeze
» Acceptability and feasibility Antibiotic treatment for non-severe pneumonia with no wheeze
» Benefits and risks Antibiotics treatment for severe pneumonia
» Acceptability and feasibility Antibiotics treatment for severe pneumonia
» Evidence and summary of findings Benefits and risks Acceptability and feasibility
» Acceptability and feasibility Salbutamol for treatment of acute wheezeasthma and
» Acceptability and feasibility Antibiotics for treatment of acute bacterial meningitis
» Benefits and risks Antibiotic treatment for Acute Otitis Media AOM
» Acceptability and feasibility Antibiotic treatment for Chronic Suppurative Otitis Media CSOM
» Benefits and risks Topical steroids for treatment of Chronic Suppurative Otitis Media
» Acceptability and feasibility Topical steroids for treatment of Chronic Suppurative Otitis Media
» Benefits and risks Antibiotic treatment for Typhoid Fever
» Acceptability and feasibility: Antibiotic treatment for Typhoid Fever
» Benefits and risks Antibiotics use in the management of severe acute malnutrition
» Acceptability and feasibility Antibiotics use in the management of severe acute malnutrition
» Acceptability and feasibility: Oxygen therapy in treatment of hypoxaemia
» Acceptability and feasibility Oxygen therapy delivery methods
» Benefits and risks Criteria for starting and stopping oxygen therapy
» Acceptability and feasibility Criteria for starting and stopping oxygen therapy
» Benefits and risks Sublingual administration of sugar in treatment of hypoglycaemia
» Acceptability and feasibility Sublingual administration of sugar in treatment of hypoglycaemia
» Benefits and risks Choice of intravenous fluids for resuscitation and maintenance in
» Vitamin K prophylaxis in newborns
» Skin-to-skin contact in the first hour of life
» Management of neonatal jaundice
» Kangaroo Mother Care Outline of the research gaps
» Prevention of hypothermia immediately after birth in VLBW infants
» Management of children with non-severe pneumonia and wheeze
» Antibiotics for severe pneumonia
» Antibiotics for very severe pneumonia
» Treatment of non-severe pneumonia
» Problems of the neonate and young infant
» Fever Severe malnutrition Hospital Care WHO evidence 0
» Children with HIVAIDS Hospital Care WHO evidence 0
» Common surgical conditions Hospital Care WHO evidence 0
» Supportive care Hospital Care WHO evidence 0
» Monitoring the child’s progress
» Counselling and discharge from hospital
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