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Thank you for your attention to this research. Firstly, this systematic review showed that LOS was decreased in the HFNC group comparing with SOT group in low-income and middle-income countries. As you mentioned in the letter that even in high-income countries, it’s not realistic to treat all bronchiolitis patients with HFNC during RSV peaks. The inconsistent result of LOS in different countries may be caused by the level of medical practice in different areas because the LOS in low-income and middle-income countries was significantly longer than in high-income countries. So the clinical heterogeneity suggested that the level of medical practice was also important for bronchiolitis. Secondly, two studies showed that patients with treatment failures in SOT group could be treated with HFNC in the wards. This meta-analysis showed that there was a significant increase in the incidence of treatment failure in HFNC group compared with nCPAP group (RR 1.61, 95% CI 1.06 to 2.42, p=0.02). Therefore, we need more research to explore which choice (HFNC or nCPAP) is better for patients with treatment failures in standard oxygen supplementation.