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Drs Huicho, Singi, and Bharti make the important points that definitions of hypoxaemia should be based on altitude-specific normal values and that further research at sea level and higher altitudes is needed. An altitude-specific definition of hypoxaemia (being an arbitrary value of SpO2 more than 21 or 3 standard deviations below the normal population mean) may be different from the threshold SpO2 for giving oxygen. Other considerations for giving oxygen are at what level of SpO2 (at different altitudes) oxygen is beneficial, local resource availability, and, in an individual child, confounding factors including the duration of exposure to altitude, age, or co-existent disease such as brain injury, severe anaemia, pulmonary hypertension, and cardiac failure.
We studied Papua New Guinean neonates and children living at an altitude of 1600m to determine normal range of oxygen saturation.2 Hypoxaemia in our study was a SpO2 more than 2SD below the mean. In practice our threshold for giving oxygen to sick children (SpO2<85%: more than 3SD below the …