Continuous neonatal evaluation in the delivery room by pulse oximetry

The pulse oximeter, a noninvasive and continuous monitor of arterial oxygenation that is reliable in adults, children, and infants, was evaluated for use in neonates in the delivery suite. One hundred newborn infants, weighing 850 to 5,230 g each, delivered vaginally or by cesarean section with general or epidural anesthesia were studied. After delivery, each infant was placed in a radiant warmer, and a pulse oximetry probe was placed on the right hand. Hemoglobin saturation was then recorded for 15 minutes. Initial pulse oximetry values were obtained in less than one minute after cord clamping in 43% of infants, less than two minutes in 81%, and less than three minutes in 98%. Average arterial oxygen saturation was 59% at 1 minute (43 infants), 68% at 2 minutes (81), 82% at 5 minutes (98), and 90% at 15 minutes (91). Oxygen saturation was less than 30% in 12 neonates and less than 50% in 26 neonates at some time during the 15-minute monitoring period. Oxygen saturation did not differ significantly between neonates delivered vaginally or by cesarean section, regardless of the presence or type of anesthetic used. Arterial oxygen saturation measured by pulse oximetry showed a statistically significant relationship when compared with the traditional Apgar scoring system. Pulse oximetry was found to be very useful in objectively judging the adequacy of resuscitative efforts, as well as in identifying children who had marked arterial desaturation during the early neonatal period.