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Pulse Oximetry Overestimates Oxyhemoglobin in Neonates with Critical Congenital Heart Disease
Daniel Murphy1, Youngju Pak, John Patrick Cleary
1Division of Neonatology, Department of Pediatrics, Los Angeles County-Harbor UCLA Medical Center, Torrance, Calif., USA.
Insights
Pulse oximetry frequently overestimates oxygen saturation in neonates with critical congenital heart disease (CCHD), potentially causing false negatives in CCHD screening and affecting clinical care. Improvements in pulse oximeter accuracy are needed for better neonatal outcomes.
Area of Science:
- Neonatal Medicine
- Cardiology
- Medical Device Technology
Background:
- Pulse oximetry is crucial for evaluating neonates with congenital heart defects.
- Routine screening for critical congenital heart disease (CCHD) using pulse oximetry was recommended in 2011.
- Concerns exist that current pulse oximeters may overestimate oxyhemoglobin in neonates with CCHD due to variable hypoxemia.
Purpose of the Study:
- To compare pulse oximetry readings with arterial oxyhemoglobin values in neonatal intensive care unit (NICU) patients diagnosed with CCHD.
- To assess the reliability of pulse oximetry in predicting actual oxyhemoglobin levels.
- To identify potential confounding variables affecting pulse oximetry accuracy, including heart lesion type, saturation range, hemoglobin concentration, peripheral perfusion, and measurement timing.
Main Methods:
- A single-center retrospective study design was employed.
- Inclusion criteria included American Heart Association-defined CCHD and concurrent umbilical artery blood gas-derived oxyhemoglobin and pulse oximetry recordings within the first 72 hours of life.
- Bland-Altman analysis and concordance correlation coefficient were used to evaluate agreement between measurements.
Main Results:
- The study analyzed 599 paired measurements from 89 neonates with CCHD.
- 47% of pulse oximetry readings were 95% or higher, exceeding the CCHD screening cutoff.
- Pulse oximetry overestimated arterial oxyhemoglobin by an average of 5.4%, with significant overestimation (>3%) occurring in 65.4% of measurements.
Conclusions:
- Current pulse oximeter technology tends to overestimate oxyhemoglobin values in neonates with CCHD.
- This overestimation may contribute to false-negative CCHD screening results and potentially lead to inappropriate care escalations.
- Enhancing the accuracy and precision of pulse oximetry in neonates is essential for improving both CCHD screening and clinical management.
Background:
Pulse oximetry is a key part of the clinical evaluation and management of neonates with congenital heart defects. In 2011, the US Department of Health and Human Services recommended use of routine pulse oximetry to screen for critical congenital heart disease (CCHD). Current studies suggest pulse oximetry overestimates arterial oxygen saturation in moderately hypoxemic pediatric patients. Based on variable hypoxemia in neonates with CCHD, concern exists that present pulse oximeter technology may overestimate measured oxyhemoglobin.
Objectives:
To compare pulse oximetry and oxyhemoglobin values in NICU patients with known CCHD to evaluate the ability of pulse oximetry to reliably predict oxyhemoglobin accounting for potential confounding variables such as heart lesion, saturation range, total hemoglobin concentration, peripheral perfusion, and timing of measurements.
Methods:
This is a single-center retrospective study. Inclusion criteria were AHA-defined CCHD and umbilical artery blood gas-derived oxyhemoglobin with concurrent pulse oximetry recording during hours of life 0-72. Bland-Altman analysis and the concordance correlation coefficient were used to measure the internal consistency (agreement) between the two measurements.
Results:
89 patients were evaluated with 599 paired arterial oxyhemoglobin and pulse oximetry recordings. 47% of all pulse oximetry values were ≥95% - the cutoff for CCHD screening. Pulse oximetry overestimated arterial oxyhemoglobin by a mean of 5.4% over all levels of oxygen saturation. Pulse oximetry overestimation was >3 in 65.4% of measurements, >6 in 41.2% of measurements, and >10 in 15.3% of measurements. Hour of life, total hemoglobin, and peripheral perfusion did not significantly affect the degree of overestimation.
Conclusions:
Our results reinforce the concern that present pulse oximeters overestimate oxyhemoglobin values, contributing to some false-negative CCHD screens and potentially leading to unnecessary escalations in care of those patients with diagnosed CCHD. Improvements in pulse oximetry accuracy and precision in the neonate would benefit both screening and clinical care in the NICU.
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