Pulse oximetry in neonates at high altitudes: a modified Colorado protocol

Area of Science:

• Neonatal screening
• Cardiology
• Pulmonology

Background:

• Pulse oximetry is a common screening tool for critical congenital heart disease (critical CHD) in newborns.
• High altitude environments present challenges for pulse oximetry due to lower average resting saturation and higher variability, leading to increased false positive results.
• Diagnostic difficulties are exacerbated in remote areas lacking advanced diagnostic equipment like pediatric echocardiography, necessitating costly patient transport.

Purpose of the Study:

• To evaluate a method for reducing diagnostic errors in critical CHD screening at high altitudes.
• To assess the utility of a 100% oxygen challenge test in differentiating true critical CHD from false positives in neonates.

Main Methods:

• The study proposes measuring arterial oxygen saturation in infants breathing 100% oxygen.
• This method aims to identify right-to-left shunting, a key indicator of critical CHD.

Main Results:

• In the absence of significant shunting, arterial oxygen saturation is expected to reach 100% with a 100% oxygen challenge.
• The presence of right-to-left shunting will result in arterial oxygen tension below 100 mmHg and saturation below 96%.

Conclusions:

• A 100% oxygen challenge test can help reduce false positive pulse oximetry readings for critical CHD at high altitudes.
• This method offers a potential solution for improving diagnostic accuracy in resource-limited settings.