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When should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxaemia
Rami Subhi1, Katherine Smith, Trevor Duke
1Centre for International Child Health, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Victoria, Australia. rami.subhi@rch.org.au
Insights
Hypoxemia thresholds for children vary by altitude. A normal arterial oxygen saturation (SpO2) of 90% at 2500m decreases to 85% at 3200m, impacting oxygen therapy guidelines.
Area of Science:
- Pediatrics
- Environmental Health
- Respiratory Medicine
Background:
- Acute respiratory infections (ARIs) cause millions of pediatric deaths globally, primarily from pneumonia and hypoxemia in developing nations.
- Effective oxygen therapy is crucial for managing ARIs, but current World Health Organization (WHO) guidelines lack altitude-specific hypoxemia definitions.
- Normal arterial oxygen saturation (SpO2) varies with altitude, necessitating adjusted hypoxemia thresholds.
Purpose of the Study:
- To define normal SpO2 levels in children residing at different altitudes.
- To establish altitude-specific hypoxemia thresholds for pediatric populations.
- To inform more accurate oxygen therapy guidelines for children in high-altitude regions.
Main Methods:
- A systematic literature review identified studies on normal SpO2 values in children aged 1 week to 12 years.
- Hypoxemia was defined as SpO2 at or below the 2.5th centile for healthy children at a given altitude.
- Meta-regression analysis modeled the relationship between altitude and SpO2, estimating mean SpO2 and hypoxemia thresholds.
Main Results:
- Prediction equations were derived for expected mean SpO2 and hypoxemia thresholds across altitudes.
- An SpO2 of 90% represents the 2.5th centile for healthy children at approximately 2500m.
- This threshold declines to 85% at approximately 3200m.
Conclusions:
- The standard WHO hypoxemia definition (SpO2 <90%) may be too inclusive at very high altitudes, potentially over-utilizing limited oxygen resources.
- An SpO2 threshold of <85% may be more appropriate for identifying children requiring oxygen supplementation in high-altitude settings.
- Altitude-specific SpO2 thresholds are essential for optimizing pediatric respiratory care in diverse geographical locations.
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 (SpO(2)) <90% does not take into account the variation in normal oxygen saturation with altitude. This study aimed to define normal oxygen saturation and to estimate the threshold of hypoxaemia for children permanently living at different altitudes.
Methods:
We carried out a systematic review of the literature addressing normal values of oxygen saturation in children aged 1 week to 12 years. Hypoxaemia was defined as any SpO(2) 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 SpO(2) and the hypoxaemia threshold with increasing altitude.
Results:
14 studies were reviewed and analysed to produce prediction equations for estimating the expected mean SpO(2) in normal children, and the threshold SpO(2) indicating hypoxaemia at various altitudes. An SpO(2) of 90% is the 2.5th centile for a population of healthy children living at an altitude of approximately 2500 m above sea level. This decreases to 85% at an altitude of approximately 3200 m.
Conclusions:
For health facilities at very high altitudes, giving oxygen to all children with an SpO(2) <90% may be too liberal if oxygen supplies are limited. In such settings, Spo(2) <85% may be more appropriate to identify children most in need of oxygen supplementation.
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