{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:46:03Z","timestamp":1775040363280,"version":"3.50.1"},"reference-count":31,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2013,11,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>Pneumonia is the leading cause of mortality in young children globally, and factors that affect tissue delivery of oxygen may affect outcomes of pneumonia. We studied whether altitude and anemia influence disease severity and outcomes in young children with World Health Organization\u2013defined severe pneumonia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We analyzed data from the SPEAR (Severe Pneumonia Evaluation Antimicrobial Research) study, a World Health Organization\u2013 and USAID-sponsored multinational randomized controlled trial of antibiotics for severe pneumonia among children aged 2 to 59 months in resource-poor settings. The trial enrolled 958 children in 8 sites at varying elevations, classified as high (\u22652000 m) or low (&amp;lt;2000 m) altitude. We compared illness severity and assessed the effect of anemia on treatment outcome at high and low altitudes, adjusting for potential confounders and study site.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Children at high altitudes had significantly lower oxygen saturation on presentation, more cyanosis, lower systolic blood pressure, and higher hemoglobin. After adjusting for potential confounders, anemia predicted treatment failure in children living at high altitude (relative risk: 4.07; 95% confidence interval: 2.60\u20136.38) but not at low altitude (relative risk: 1.12; 95% confidence interval: 0.96\u20131.30). Children at high altitude took longer to reach normoxemia than did children at lower altitudes (5.25 vs 0.75 days; P &amp;lt; .0001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Children at high altitude present with more severe disease, and children with anemia at high altitude are at greater risk of poor outcome when being treated for severe pneumonia. Given the high global prevalence of anemia among young children, prevention and treatment of anemia should be a priority in children living at high altitude and could improve outcomes of pneumonia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2013-0761","type":"journal-article","created":{"date-parts":[[2013,10,8]],"date-time":"2013-10-08T01:10:17Z","timestamp":1381194617000},"page":"e1156-e1162","source":"Crossref","is-referenced-by-count":25,"title":["Childhood Anemia at High Altitude: Risk Factors for Poor Outcomes in Severe Pneumonia"],"prefix":"10.1542","volume":"132","author":[{"given":"Peter P.","family":"Moschovis","sequence":"first","affiliation":[{"name":"Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salem","family":"Banajeh","sequence":"additional","affiliation":[{"name":"Sana\u2019a University, Sana\u2019a, Yemen;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William B.","family":"MacLeod","sequence":"additional","affiliation":[{"name":"Center for Global Health and Development, Boston University, Boston, Massachusetts;"},{"name":"Department of International Health, Boston University School of Public Health, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samir","family":"Saha","sequence":"additional","affiliation":[{"name":"Dhaka Shishu Hospital, Dhaka, Bangladesh;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"Hayden","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David C.","family":"Christiani","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;"},{"name":"Harvard School of 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