Racial discrepancy in pulse oximeter accuracy in preterm infants

Area of Science:

• Neonatal Medicine
• Medical Device Accuracy
• Health Disparities

Background:

• Pulse oximetry is a standard tool in neonatal care for monitoring oxygen saturation.
• Emerging adult data indicate potential racial disparities in pulse oximetry accuracy, specifically overestimation in Black individuals.

Purpose of the Study:

• To investigate racial differences in pulse oximetry accuracy among preterm infants.
• To determine if Black infants experience greater overestimation of oxygen saturation compared to White infants.

Main Methods:

• Simultaneous arterial blood gas and pulse oximetry measurements were taken in Black and White infants under 32 weeks gestation.
• Statistical analyses included mean bias, A_rms, Bland-Altman, and linear/non-linear analysis to assess error by race.

Main Results:

• A total of 294 infants (124 Black, 170 White) with 4387 data points were analyzed.
• Mean bias indicated a 2.4-fold greater overestimation of SpO₂ in Black infants.
• Occult hypoxemia (SpO₂ >90% when SaO₂ <85%) was more frequent in Black infants (9.2% vs. 7.7%).

Conclusions:

• A consistent, albeit modest, difference in SpO₂ error exists between Black and White infants.
• Black infants exhibit a higher incidence of occult hypoxemia due to pulse oximetry inaccuracies.