Neonatal Pulse Oximetry Accuracy and Disparities by Skin Pigmentation (NeoPODS): A Prospective Study

Area of Science:

• Neonatal Medicine
• Clinical Diagnostics
• Biomedical Engineering

Background:

• Pulse oximetry saturation (SpO₂) is a non-invasive method for monitoring oxygenation.
• Accurate SpO₂ readings are crucial in neonatal care, especially in intensive care settings.
• Potential discrepancies between SpO₂ and arterial oxygen saturation (SaO₂) in newborns with different skin pigmentation warrant investigation.

Purpose of the Study:

• To evaluate the bias between SpO₂ and SaO₂ in neonates.
• To determine if skin pigmentation influences the accuracy of SpO₂ measurements.
• To assess the incidence of occult hypoxemia (SaO₂ < SpO₂) in relation to skin pigmentation.

Main Methods:

• A prospective diagnostic accuracy study was conducted in two tertiary neonatal intensive care units.
• Paired SpO₂ and SaO₂ measurements were obtained from 136 neonates (within 10 postnatal days) with arterial catheters.
• Skin pigmentation was assessed using individual typology angle (ITA) and melanin index; SpO₂-SaO₂ bias was calculated.

Main Results:

• The overall mean bias was -0.98%, indicating a slight underestimation of SaO₂ by SpO₂.
• No statistically significant differences in bias were found across categorical skin pigmentation or race.
• Continuous analysis showed bias becoming less negative with lighter skin pigmentation (significant for ITA). Occult hypoxemia was rare.

Conclusions:

• SpO₂ slightly underestimates SaO₂ in neonates.
• Clinically significant disparities in SpO₂-SaO₂ bias related to skin pigmentation were not observed in this study.
• The findings suggest pulse oximetry remains a reliable tool for oxygenation monitoring in neonates across different skin tones.