Abstract
Pulse oximetry has emerged as a convenient and readily available tool for monitoring of resuscitation. This study was done to evaluate the ability of the pulse oximetry to record oxygen saturation of asphyxiated neonates as well to note serial changes in oxygen saturation during their resuscitation. The main outcome was time taken to reach 90% saturation as recorded by pulse oximeter. The other variables were the time when first recording could be taken by pulse oximeter and time taken to reach 75% saturation. 100 cases (asphyxiated newborns) and 30 controls (normal newborns) were included in the study. The mean heart rate at one minute of age was significantly lower in the asphyxiated group (91±5.24 per minute) as compared to controls (125.2±4.5 per minute). The mean oxygen saturation at one minute of age was also significantly lower for asphyxiated group (47.5%±1.42) as compared to controls (50.5%±2.08). The median (inter quartile range) time taken in seconds to reach 75% and 90% saturation was 290 (275-295) and 490(480-510) seconds in the asphyxiated group was significantly higher (p<0.05) as compared to controls where it was 205 (190-212) and 375 (357-398). Both Asphyxiated and normal newborns remain relatively desaturated in early minutes of life. Pulse oximetry could detect these significant differences in the oxygen saturation and heart rate during initial periods of resuscitation, but as resuscitation continued these differences became non significant indicating the adequacy of resuscitation in asphyxiated newborn. This can be utilized as a cost effective tool in the neonatal unit in peripheral centers with less facilities in developing countries as ours to check for adequacy of resuscitation and intensive care referrals if needed , particularly for the primary care physicians who need to be well versed about the adequacy of resuscitation.
Highlights
Asphyxia neonatorum or birth asphyxia is the respiratory failure in newborn a condition caused by inadequate intake of oxygenbefore during or just after birth
The number of cases(%) in whom pulse oximetry recordings could be obtained at 1 minute, 3 minutes, 5 minutes and 10 minutes was 8(8.00%), 36(36.00%), 62(62.00%) and 92(92.00%), respectively as compared to the controls in whom the number (%0) of pulse oximetry records obtained at same intervals were 4(13.3%), 22(73.30%) 29(96.70%)and 29(96.70%), respectively.The percentage of pulse oximetry recordings obtained at 3 and 5 minutes was significantly lower (p
The previous studies done by House et al (6) on normal newborns infants,initial oximetry recordings were obtained in 43% of infants at 1 minute of age and by 5 minutes this percentage increased to about 98% similar percentage of recordings were obtained by Meier-Strauss et al (5)
Summary
Asphyxia neonatorum or birth asphyxia is the respiratory failure in newborn a condition caused by inadequate intake of oxygenbefore during or just after birth. It is defined as the failure to start regular respiration within one minute of birth.It is a neonatal emergency as it may lead to hypoxia and brain damage. Newborn infants normally start to breathe without assistance and usually cry after birth. If an inewborn fails to establish sustained respiration at birth, the newborn is diagnosed with birth Asphyxia (1). Birth asphyxia accounts for an estimated 0.92 million neonatal deaths annually and is associated with another 1.1 million intrapartum still births (3). Keeping in view the Mortality and morbidity associated with neonatal asphyxia, prompt assessment and resuscitation of asphyxiated newborns assumes great significance. All resuscitation efforts should aim at achieving adequate level of oxygenation of newborns in order to prevent any hypoxic damage. Pulse oximetry provides a real time non ivasive method of measuring oxygenation and has emerged as a useful tool for monitoring resuscitation
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