Pulse oximetry in newborns: What should we use it for and when should we use it?

Abstract

The use of technology to improve diagnosis is always attractive if it can substantially add to our diagnostic capability. The use of pulse oximetry in newborns, particularly for screening for the presence of congenital heart disease, has been controversial. In this issue of The Journal, two papers and an editorial provide useful information in this debate. Meberg et al reported on the results of a population-based prospective study of pulse oximetry in the first day of life to detect congenital heart defects. They were able to screen over 50 000 live births. Based on their data at the birth and in follow-up, they concluded that pulse oximetry screening is useful in detection of congenital heart diseases and other potentially severe abnormalities. Kamlin et al evaluated the use of pulse oximetry to measure heart rate in newborn infants in the delivery room. They concluded that pulse oximetry provides an accurate measure of heart rate in the newborn. In his editorial, Mahle helps to put these results in perspective. He indicates that both results are potentially useful, but he cautions that pulse oximetry should not give us a false sense of security. Some infants with important congenital heart disease were still missed despite oximetry. False positives were also relatively high. He emphasizes that timing is an important issue for the oximetry measurement. To detect congenital heart disease, the pulse oximetry measurement should probably occur after 24 hours of life, but before hospital discharge. Although, oximetry in the delivery room may have other uses, it is not optimum for congenital heart disease screening.