Pulse oximeter in the neonatal ICU: a correlational analysis

In critically ill neonates the risk associated with rapid changes in oxygen saturation is high. Thus effective means of monitoring blood oxygen saturation is essential. While pulse oximetry is appealing because it is noninvasive and in general it correlates well with arterial blood gases (ABG), some concerns remain about its accuracy in certain circumstances. An extensive review of the literature of pulse oximetry revealed several conditions in adults that may affect the accuracy, including: anemia, low pulse pressure, and elevated lipids. Less research has been done with children and neonates. This study examined pulse oximetry and ABG values in critically ill neonates. Ninety-three sampling events were used to examine the effects of the following variables on the accuracy of pulse oximetry in the neonate: gestational age, chronological age, diagnosis, anemia, hyperbilirubinemia, hyperalimentation, lipid infusions, inotropic agents. For several of these variables (anemia, hyperbilirubinemia, hyperalimentation, lipid infusion, inotropic drugs), correlations between pulse oximetry and ABG values were low, raising concerns about the use of pulse oximetry in the critically ill neonate.