Racial discrepancy in pulse oximeter accuracy in preterm infants

Pulse oximetry is commonly used in Neonatology, however recent adult data suggest racial disparity in accuracy, with overestimation of oxygen saturation for Black patients.

Black and White infants <32 weeks gestation underwent simultaneous arterial blood gas and pulse oximetry measurement. Error by race was examined using mean bias, A_rms, Bland-Altman, and linear/non-linear analysis.

A total of 294 infants (124 Black, 170 White) were identified with mean GA of 25.8 ± 2.1 weeks and mean BW of 845 ± 265 grams, yielding 4387 SaO₂-SpO₂ datapoints. SpO₂ overestimation, measured by mean bias, was 2.4-fold greater for Black infants and resulted in greater occult hypoxemia (SpO₂ > 90% when SaO₂ < 85%; 9.2% vs. 7.7% of samples). Sensitivity and specificity for detection of true hypoxemia were similar between groups (39 vs. 38%; 81 vs. 78%).

There is a modest but consistent difference in SpO₂ error between Black and White infants, with increased incidence of occult hypoxemia in Black infants.