ABSTRACT Objectives: The primary objective was to determine normative values of oxygen saturation (SpO2) by pulse oximetry in apparently healthy children, aged 1 month to 14 years. The secondary objective was to explore any variation in oxygen saturation levels by age and gender. Materials and Methods: It was a cross-sectional study conducted at a tertiary care centre and schools in Bhubaneswar, Odisha, India, from January 2021 to December 2022. Apparently healthy children were enrolled. Using a standardized pulse oximeter and appropriately sized probes, SpO2 was recorded after stabilization of plethysmograph waves. Three consecutive readings were taken, and an average was noted. The 2.5th centile SpO2 value was taken as the lower limit of normal. Results: The median (IQR) saturation of the sample population was 99.7% (99–100). The 2.5th, 5th, 25th, and 75th percentiles were 97.7%, 98%, 99%, and 100%, respectively. Median SpO2 and its percentiles were estimated for each age group. The 2.5th centile SpO2 for infantile age group was 96.4%. No significant age and gender-wise variations of SpO2 were noted. Conclusions: The present study established normal reference range oxygen SpO2 levels in apparently healthy children from an eastern India region that is situated at 62 m (204 ft) above the sea level.

<h4>Background</h4>High-flow nasal cannula (HFNC) therapy is increasingly used for lower respiratory tract infections (LRTIs) in infants and young children, but recommendations vary, and standardised practice is lacking.<h4>Objective</h4>To systematically review national or international guidelines on HFNC use in children aged 1-23 months with LRTIs, focusing on initiation, administration, monitoring, discontinuation and feeding.<h4>Methods</h4>We searched MEDLINE, EMBASE, CINAHL, Web of Science and professional society websites (2014-2025) for guidelines on HFNC use in this age group. Four reviewers independently screened, extracted data and assessed quality with the AGREE II tool. Interguideline concordance was calculated for all guidelines and separately for those addressing bronchiolitis and for evidence-based versus consensus-based guidelines. Recommendations were synthesised narratively.<h4>Results</h4>Fifteen guidelines were included, including nine bronchiolitis guidelines. All addressed HFNC initiation, with low oxygen saturation (73%) and respiratory distress (47%) as common indications. Initial flow recommendations varied; 2 L/kg/min was most frequent (57%), and all bronchiolitis guidelines reporting it advised weight-based settings. Only two guidelines included weaning or discontinuation protocols, and seven addressed failure criteria. Monitoring typically included pulse oximetry and clinical observation; pulse oximetry was endorsed by all bronchiolitis guidelines that reported it (8/9). Enteral feeding was supported by all reporting guidelines (6/15). Guideline quality was moderate to high, though applicability and updating were frequent gaps.<h4>Conclusions</h4>HFNC guideline recommendations for young children with LRTIs remain inconsistent, particularly regarding weaning, failure criteria and procedural details. Regular updates and greater standardisation are needed to improve care and optimise resource use.<h4>Prospero registration number</h4>CRD42024622544.

arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise in arterial Respiratory failure results from inadequate gas exchange by the respiratory system, meaning that the arterial oxygen, carbon dioxide, or both cannot be kept at normal levels. A drop in the oxygen carried in the blood is known as hypoxemia; a rise in arterial carbon dioxide levels is called hypercapnia. Respiratory failure is classified as either Type 1 or Type 2, based on whether there is a high c Type…

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