Abstract

Background: Acute respiratory infections (ARI) cause 3 million deaths in children worldwide each year. Most of these deaths occur from pneumonia in developing countries, and hypoxaemia is the most common fatal complication. Simple and adaptable indications for oxygen therapy are important in the management of ARI. The current WHO definition of hypoxaemia as any arterial oxygen saturation (SpO2) below 90% does not take into account the variation of normal oxygen saturation with altitude. This study aimed to define the normal oxygen saturation and to estimate the threshold of hypoxaemia for children permanently living at different altitudes.

Methods: We did a systematic review of the literature addressing normal values of oxygen saturation in children aged between 1 week and 12 years. Hypoxaemia was defined as any SpO2 at or below the 2.5th centile for a population of healthy children at a given altitude. Meta-regression analysis was performed to estimate the change in mean SpO2 and the hypoxaemia threshold with increasing altitude.

Results: A total of 14 studies were reviewed and analyzed to produce prediction equations for estimating the expected mean SpO2 in normal children, and the threshold SpO2 indicating hypoxaemia at various altitudes. An SpO2 of 90% is the 2.5th centile for a population of healthy children living at an altitude of around 2500 metres above sea level. This decreases to 85% at an altitude of approximately 3200 metres.

Conclusions: For health facilities at very high altitudes, giving oxygen to all children with an SpO2 less than 90% may be too liberal if oxygen supplies are limited. In such settings, SpO2<85% may be more appropriate to identify children most in need of oxygen supplementation.