Evidence map›Paper›PMID 42679843›Full record

SynthesisThe Lancet. Global health2026

Hypoxaemia and mortality in children with lower respiratory infection in low-income and middle-income countries: systematic review and meta-analysis.

Nadia E Hoekstra, Kristen S Joseph, Holly B Schuh, Laura Ruegsegger, Claire Twose, Tim Colbourn, Shubhada Hooli, William Checkley, Carina King, Stephen Rc Howie and 5 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The Lancet. Global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Nadia E HoekstraDepartment of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA; Global Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: nadia_hoekstra@med.unc.edu.
Kristen S JosephGlobal Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Anesthesia and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Holly B SchuhGlobal Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Laura RuegseggerCincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Claire TwoseWelch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Tim ColbournInstitute for Global Health, University College London, London, UK.
Shubhada HooliGlobal Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
William CheckleyDivision of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Carina KingDepartment of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
Stephen Rc HowieDepartment of Pediatrics, Child & Youth Health, University of Auckland, Auckland, Aotearoa New Zealand; College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
Hamish R GrahamMelbourne Children's Global Health, MCRI, University of Melbourne, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria.
Marzia LazzeriniWHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy; Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, UK.
Tisungane MvaloDepartment of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, USA; University of North Carolina Project Malawi, Lilongwe, Malawi.
Heather J ZarDepartment of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa.
Eric D McCollumGlobal Program in Pediatric Respiratory Sciences, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: emccoll3@jhmi.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHypoxaemic lower respiratory infections (LRIs) are a leading cause of childhood mortality, with the highest burden in low-income and middle-income countries (LMICs). Hypoxaemia-low peripheral capillary oxyhaemoglobin saturation (SpO

methodsWe conducted a systematic review with meta-analysis by searching PubMed, Embase, LILACS, Global Index Medicus, Web of Science, and Scopus for peer-reviewed studies published between Jan 1, 2015, and June 18, 2025, with combined terms related to pneumonia, children, mortality, and LMICs. We also included selected earlier studies through citation checking. Eligible studies reported associations between hypoxaemia and mortality in children younger than 5 years with LRIs in LMICs. We excluded case reports and case series with fewer than five deaths, studies focused exclusively on the neonatal period, and those limited to children with specific comorbidities or to postoperative patients, for consistency with the original review. Two reviewers independently screened studies, extracted data, and assessed quality. Eligible studies were combined with those from the original review and analysed using random-effects models to estimate odds ratios (ORs) by hypoxaemia threshold subgroup. The protocol was registered on PROSPERO (CRD42023433946).

findingsWe identified 7734 records; 26 new studies met inclusion criteria and were combined with 18 from the original review. The 44 studies were published between 1993 and 2024 and were primarily from Africa (25 [57%] of 44) or Asia (19 [43%]); some studies spanned multiple locations. Data from 33 studies including 155 633 participants were included in the primary meta-analysis. Hypoxaemia of any threshold was associated with higher odds of LRI mortality (OR 4·36 [95% CI 3·52-5·39]) compared with no hypoxaemia. For SpO

interpretationSpO

fundingNone.

Indexed as

Developing CountriesHypoxiaRespiratory Tract InfectionsChildChild, PreschoolHumansInfantResource-Limited Settings

Identifiers

PMID42679843
PMCPMC13652795

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.