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Pulse oximetry reliability for detection of hypoxemia under motion in extremely premature infants
Alaleh Dormishian1,2, Alini Schott1, Ana Cecilia Aguilar1
1Division of Neonatology, Departments of Pediatrics, Miller School of Medicine, Miami, FL, USA.
Insights
Motion artifact in extremely premature infants is more likely to indicate true hypoxemia than false hypoxemia, improving pulse oximetry (SpO2) reliability. This finding aids caregivers in trusting SpO2 readings during hypoxemic events.
Area of Science:
- Neonatal physiology
- Medical instrumentation
- Clinical monitoring
Background:
- Intermittent hypoxemia (IH) is common in extremely premature infants.
- Pulse oximetry (SpO2) is used to detect IH, but motion artifact can lead to inaccurate readings.
- Caregiver trust and response can be affected by uncertainty regarding SpO2 accuracy during motion artifact.
Purpose of the Study:
- To evaluate the reliability of SpO2 during IH episodes associated with motion in premature infants (≤28 weeks gestational age).
- To assess the impact of motion artifact on SpO2 readings in this vulnerable population.
Main Methods:
- Simultaneous monitoring of SpO2 using two pulse oximeters on different extremities in premature infants.
- Classification of IH episodes based on SpO2 values and pulse plethysmograph (Pleth) distortion due to motion.
- Categorization into true hypoxemia (A, D) and false hypoxemia (B) based on oximeter and Pleth data.
Main Results:
- Analysis of data from 20 infants (25.4 ± 1.5 weeks GA) revealed frequent IH episodes.
- Episodes with SpO2 < 90% were classified as Type A (29%), B (1%), C (43%), and D (27%).
- Episodes with SpO2 < 80% were classified as Type A (26%), B (0.3%), C (45%), and D (19%), with Type B significantly lower (p < 0.001).
Conclusions:
- In extremely premature infants, SpO2 readings during motion artifact are more indicative of true hypoxemia than false hypoxemia.
- This suggests a higher reliability of SpO2 monitoring even amidst motion challenges in this population.
- Findings can help improve clinical decision-making and caregiver confidence in managing hypoxemic episodes.
Background:
Episodes of intermittent hypoxemia (IH) in extremely premature infants are detected by pulse oximetry (SpO2) but motion artifact can cause falsely low readings.
Objectives:
To evaluate the reliability of SpO2 during IH episodes associated with motion in premature infants of ≤28 weeks GA monitored with 2 pulse oximeters.
Methods:
IH episodes (defined as SpO2 < 90%, >10 s and SpO2 < 80%, >10 s) were classified by an analytic tool based on distortion caused by motion in the pulse plethysmograph (Pleth) as: A (true hypoxemia), both SpO2 decreased (only one Pleth showed motion); B (false hypoxemia), one SpO2 decreased (Pleth showed motion) and the other didn't (Pleth didn't show motion); C (suspected hypoxemia), both SpO2 decreased (both Pleth showed motion); D (true hypoxemia-motion free), both SpO2 decreased (neither Pleth showed motion).
Results:
In 24-72 h data from 20 infants of 25.4 ± 1.5 weeks GA, 14.1 ± 5.7 episodes with SpO2 < 90% and 7.9 ± 5.5 episodes with SpO2 < 80% per infant were identified. 29 ± 15% of episodes with SpO2 < 90% were type A, 1 ± 2% B, 43 ± 21% C and 27 ± 23% D, while 26 ± 22% of episodes with SpO2 < 80% were type A, 0.3 ± 1.2% B, 45 ± 29% C, and 19 ± 25% D [p < 0.001 type B vs. rest (GLM-repeated measures)].
Conclusion:
In extremely premature infants SpO2 with motion artifact is more likely to indicate true- than false hypoxemia.
Impact:
Uncertainty on the effect of motion on SpO2 accuracy during hypoxemia episodes in premature infants can influence the caregiver's trust on SpO2 and influence their response. This study evaluated data from two pulse oximeters used simultaneously in different extremities to determine the reliability of SpO2 during motion artifact in premature infants. Data from this study showed that in extremely premature infants SpO2 is more likely to indicate true- than false hypoxemia during episodes of hypoxemia associated with motion artifact.
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