Abstract
Background: Pulse oximetry is a noninvasive technique of measuring oxygenation of the blood that is used worldwide to assess critically ill patients. The accuracy of pulse oximetry reading may be related to the site of pulse oximeter probe placement; but this may be difficult in sick neonates. In neonates, palm and sole are commonly used site for probe placement.
 Objective: This study was conducted to assess the accuracy of pulse oximeter oxygen saturation (SpO2) from probe placement at wrist and ankle as an alternative to palm and sole in neonates.
 Methods: This cross sectional study was carried out in SCABU of Dhaka Shishu (Children) Hospital from December 2012 to March 2013. A total of 169 neonates were enrolled in this study. Two pulse oximeters were used for simultaneous paired SpO2 measurements. The SpO2 was measured at 0 sec, then at 30 sec and at 1 min over the palm and ipsilateral wrist, both side and repeated the same procedure over the sole and ipsilateral ankle, both side and were recorded in the case record form. Two tailed, Student’s t-test was performed for analysis of continuous, normally distributed variables. Regression analysis was performed to determine the relationship between paired SpO2 measurements.
 Results: A total of 169 patients (birth weight 2530.8±772.2 g, gestational age 36.7±3.9 weeks, mean age 7.7 days and age range 1-27 days) were enrolled. There was a good correlation between SpO2 measured at the palm versus the wrist (r= 0.92, p<0.0001 (right); r= 0.88, p< 0.0001 (left)) and between SpO2 measured at the sole versus the ankle (r=0.90, p<0.0001 (right); r= 0.98, p<0.0001 (left)). There was also a good agreement between paired SpO2 measurements from these sites. The bias and precision for SpO2 at the right palm and right wrist was 0.08 ± 0.65% and for the left palm and left wrist 0.05 ± 0.79%. Similarly, the bias and precision for SpO2 at the right sole and right ankle was -0.11 ± 0.63% and for the left sole and left ankle was 0.56 ± 0.32%.
 Conclusion: The wrist and ankle can be used as alternative sites, to measure SpO2 in newborn infants in place of the routinely used palm or sole.
Highlights
Pulse oximeter arterial oxygen saturation (SpO2) has become the "fifth vital sign" in the examination of every newborn and infant with respiratory distress, besides temperature, pulse, respiration and blood pressure.[1,2,3] Pulse oximetry is noninvasive, easy to use, has no side effects, is accurate and allows continuous monitoring and is the preferred method of oxygen monitoring in neonate.[4,5] Pulse oximeter estimates arterial oxygen saturation by measuring the absorption of light in human tissue beds and light isThe ideal site for placement of probe is one that is well perfused, relatively immobile, comfortable for the patients and accessible
There was a good correlation between SpO2 measured at the palm versus the wrist (r= 0.92, p
The wrist and ankle can be used as alternative sites, to measure SpO2 in newborn infants in place of the routinely used palm or sole
Summary
Pulse oximeter arterial oxygen saturation (SpO2) has become the "fifth vital sign" in the examination of every newborn and infant with respiratory distress, besides temperature, pulse, respiration and blood pressure.[1,2,3] Pulse oximetry is noninvasive, easy to use, has no side effects, is accurate and allows continuous monitoring and is the preferred method of oxygen monitoring in neonate.[4,5] Pulse oximeter estimates arterial oxygen saturation by measuring the absorption of light in human tissue beds and light isThe ideal site for placement of probe is one that is well perfused, relatively immobile, comfortable for the patients and accessible. Wrist or ankles have been an alternative site for pulse oximeter probe location in these critically ill neonates requiring oxygen saturation monitoring.[10] the performance of the pulse oximeter can be disrupted by several factors including poor peripheral perfusion, peripheral vasoconstriction, hypotension, low pulse pressure and patients motion.[11] On the other hand, prolong placement of probe can cause mechanical injury (e.g., finger stiffness), ischaemic pressure necrosis, burning or blistering of the placement site.[8] So, alternative site for probe placement is needed in critically ill and sick neonates. This study was undertaken to see whether the wrist and ankle can be the alternative site for pulse oximeter probe placement in sick newborn to monitor oxygen saturation. Palm and sole are commonly used site for probe placement
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