Background: In developing countries were health providers have to rely on signs and symptoms to identify hypoxemia in pneumonia and start oxygen therapy, this study was therefore conducted to assess the prevalence and predictors of hypoxemia with the hypothesis to design a severity score for hypoxemia in children with pneumonia.Methods: This prospective observational study was carried out at the paediatric emergency department of Gajra Raja Medical College, Gwalior, on children of age 1-60 months admitted with respiratory illness categorised on basis of “Revised WHO Classification of Pneumonia”. Various demographic and clinical features were noted. Oxygen saturation was measured via a pulse oximeter. Hypoxemia was defined as SpO2 <90%. Statistical analysis was done.Results: Of the 200 children studied, 67 (33.5%) had hypoxemia. Fever, breathing difficulty, and crepitations were the most sensitive, while inability to feed, cyanosis, grunting, head nodding and impaired consciousness were the most specific indicators for hypoxemia. Fever, lethargy, inability to feed, nasal flaring, grunting, impaired consciousness and cyanosis were found significant (p value<0.05). Combinations of tachypnea with nasal flaring, grunting, cyanosis, and retractions with grunting were also found significant in predicting hypoxemia. Combinations of tachypnea with grunting (90.2%) and cyanosis (94.7%) were found highly specific.  Using these combinations, a new hypoxemia scoring system was designed to predict the severity of hypoxemia.Conclusions: Study suggested that combination of clinical signs may be utilized as markers for hypoxemia in conditions where pulse-oximeter is not available.

Edwards syndrome, a rare genetic disorder is characterized by the extra copy of chromosome 18. About 50% babies with this syndrome do not survive one week of age and approx. 95% do not survive past the first year of life. The syndrome is usually characterized by dysmorphic facies, microcephaly, flexion finger deformity and rocker- bottom feet. There is involvement of cardiacvascular and renal system with intellectual disability. Authors report a case of Edwards syndrome presenting with failure to thrive and developmental delay in the absence of usual clinical features of Edwards syndrome.