Abstract
Introduction: Pulse oximetry is widely used in Neonatal intensive care setting. Both wrist and ankle are widely used as substitute sites for probe placement in place of more commonly used sites such as palm and sole. However, little is known about the accuracy and response time of pulse oximetry when the probe is placed at wrist or ankle of neonates.
 Objectives: The primary objective of this study was to compare the values of SpO2 reading at wrist with palm and ankle with sole in terms of correlation and accuracy. The secondary objective was to compare the response time to get a valid SpO2 reading at wrist with palm and ankle with sole.
 Methodology: This was a prospective observational study conducted at Neonatal intensive care unit of Biratnagar Hospital from October 2020 to January 2021. After approval from institutional review committee, a total of 152 consecutive neonates admitted in NICU of either gender both term and preterm were enrolled for the study. Recording of SpO2, heart rate and response time was done by two pulse oximeters simultaneously. The SpO2 measurements at right palm and right wrist were recorded at 0, 30 seconds and 1 minute then simultaneous recording was done for the left palm and left wrist, right sole and ankle and left sole and ankle. Response time was also recorded for each of the readings.
 Results: The results of our study show good correlation using regression analysis and good agreement using Bland- Altman plots between the values of SpO2 reading of paired measurements. The response times of the paired measurements were not significantly different. There was good correlation between the SpO2 of paired measurements. The correlation for right palm and wrist was 0.927 (P-value = 0.01) and that of left palm and wrist was 0.85 (P-value = 0.01). Similarly the correlation between right sole and ankle and left sole and ankle were 0.937 (P-value = 0.01) and 0.875 (Pvalue = 0.01) respectively. The bias (average difference) and precision (standard deviation of differences) were calculated. The bias and precision of the right palm and wrist, left palm and wrist, right ankle and sole; and left ankle and sole were (-0.00289, 0.76105), (-0.17982, 0.95049), (-0.03509, 0.786342) and (-0.14474, 0.859241) respectively.
 Conclusion: Wrist and ankle can be used as substitute sites for pulse oximter placement in neonatal intensive care setting.
Highlights
The results of our study show good correla on using regression analysis and good agreement using BlandAltman plots between the values of SpO2 reading of paired measurements
Wrist and ankle can be used as subs tute sites for pulse oximter placement in neonatal intensive care se ng
The arterial oxygen satura on using pulse oximetry is commonly employed in neonatal intensive care as the fi h vital sign
Summary
The arterial oxygen satura on using pulse oximetry is commonly employed in neonatal intensive care as the fi h vital sign. Finger probes appear to be more accurate than forehead, nose or earlobe probes during low perfusion states.[7] This can be a problem in newborn babies. Infants both term and preterm tend to have poor peripheral perfusion (acrocyanosis) in the first few hours of life. This can result in low signal strength and can affect the detec on or processing of the biological signals thereby affec ng the accuracy of pulse oximetry resul ng in inaccurate signal and false alarm.[4,6,7]. Li le is known about the accuracy and response me of pulse oximetry when the probe is placed at wrist or ankle of neonates. Pulse oximeter response me is important for resuscita on purpose
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