Oximetry In Children Research Articles

Reference values for cerebral and peripheral tissue oximetry in children: A clinical TD-NIRS study.

Current non-invasive near-infrared spectroscopy (NIRS) tissue oximetry suffers from suboptimal reproducibility over probe repositioning, hindering clinical threshold establishment. Time Domain-NIRS (TD-NIRS) offers higher precision but lacks sufficient paediatric data, preventing effective clinical application. We aimed to establish reference ranges for cerebral and mid-upper arm (MUA) tissue haemodynamics in paediatric subjects using TD-NIRS and explore correlations with auxological variables. TD-NIRS measurements were conducted acquiring data from cerebral and MUA regions with the NIRSBOX tissue oximeter. Morphological and clinically relevant information were collected to explore potential correlations with TD-NIRS derived parameters. TD-NIRS assessment was applied in 350 children (8.4 ± 5.0 years). Precision of TD-NIRS was demonstrated with standard deviations of 0.9% (StO2) and 4.2 μM (tHb) for frontotemporal cerebral cortex, and 0.8% (StO2) and 3.7 μM (tHb) for MUA. No user dependency was observed. The trends of values for cerebral and peripheral regions vary differently according to age and auxological parameters. This study reports resting-state optical and haemodynamic values for a healthy paediatric population, providing a foundation for future investigations into clinically relevant deviations in these parameters. Furthermore, correlations with anthropometric and demographic values provide valuable insights for a deeper understanding of tissue haemodynamic evolution in childhood.

Sleep studies in obese children with obstructive sleep apnea: Pulse oximetry as a diagnostic tool.

Obstructive sleep apnea is associated with many co-morbidities in children and young people. Obesity has long been recognised as an important risk factor associated with obstructive sleep apnea. Currently, polysomnography is regarded as the gold-standard diagnostic tool for obstructive sleep apnea. The validity of oximetry as a screening and diagnostic tool for obstructive sleep apnea has been the subject of several studies in the literature. There is little published evidence on the use of oximetry in children with obesity. This study assesses whether oximetry is a reliable diagnostic tool for obstructive sleep apnea in obese children. We reviewed the medical records of obese children with a suspected diagnosis of obstructive sleep apnea who underwent oximetry and cardiorespiratory polygraphy or full polysomnography at Sheffield Children's Hospital between January 2010 and March 2022. We compared oximetry results with the apnea-hypopnea index from cardiorespiratory polygraphy or full polysomnography for each patient. A total of 60 patient records were included in the analysis. The sensitivity of oximetry in diagnosing obstructive sleep apnea was 70.9%, with a specificity of 65.5% and a positive predictive value of 68.75%. In the subgroup of subjects with severe obstructive sleep apnea (apnea-hypopnea index > 10), oximetry had a sensitivity of 87.5%. We concluded that oximetry could be a helpful initial diagnostic tool for obstructive sleep apnea in obese children, but is not entirely reliable. A negative oximetry result in a symptomatic individual should prompt a referral for more detailed investigations, while a positive result can help in treatment decisions without needing a polysomnography.

Pulse oximetry in children

Pulse oximeters detect and quantify the degree of hypoxaemia in a way that is non-invasive, relatively inexpensive, and simple to perform. This makes pulse oximeters ideal for use in children in the primary care setting. However, although many GPs now have access to a pulse oximeter, few have received formal training in pulse oximetry and many are unaware of the potential for pulse oximeters to produce inaccurate readings in some patients and in some circumstances. This article discusses the use of pulse oximetry in children and highlights the need for GPs to be aware of the factors that can cause oxygen saturation readings to be inaccurate or misinterpreted.

Evaluating the Accuracy of Pulse Oximetry in Children According to Race

This cross-sectional study investigates the association between race and pulse oximeter accuracy in children in the US.

Novel Indices to Improve the Diagnostic Ability of Nocturnal Oximetry in Children with OSAS

Nocturnal pulse oximetry (NOx) is an alternative diagnostic test for obstructive sleep apnea syndrome (OSAS) in childhood yet with variable diagnostic performance. Our aim was to apply advanced signal analysis to develop novel and more accurate NOx indices. We studied 45 children aged 3-10 years who underwent adenotonsillectomy for adenotonsillar hypertrophy and OSAS symptoms. Participants performed NOx before and three months after surgery, and the changes in McGill oximetry score (MOS), oxygen desaturation ≥3% index (ODI3), and the novel parameters-cumulative saturation area (CSA) and oxygen saturation sample entropy (SSE)-were assessed. There was a significant improvement (p < 0.001) in all NOx indices. When pre- and post-adenotonsillectomy NOx recordings were compared, the MOS had an area under the curve (AUC) of 0.811 with 63.2% sensitivity and 100% specificity at a cutoff >1. The AUC of ODI3 was 0.994, with 97.8% sensitivity and 91.1% specificity at a cutoff of >3.6 events per hour. The CSA and SSE had an AUC of 1.00, with 100% sensitivity and specificity at a cutoff of >293 and >0.99, respectively. We conclude that the herein-introduced indices-CSA and SSE-hold promise in improving the diagnostic ability of NOx in children suspected of OSAS.

Неинвазивный мониторинг церебральной оксиметрии у детей

В данном обзоре представлен ряд литературных источников, описывающих применение церебральной оксиметрии с использованием инфракрасной спектроскопии у детей. Множество клинических исследований показывают, что, несмотря на некоторые недостатки, неинвазивный мониторинг церебральной оксиметрии является важным инструментом защиты мозга, в первую очередь там, где может присутствовать ятрогенная ишемия головного мозга. Возрастает и количество данных об использовании инфракрасной спектроскопии в таких областях, как педиатрическая кардиохирургия, педиатрическая нейрохирургия, педиатрическая и неонатальная интенсивная терапия. В целом исследования показывают возрастающую роль мониторинга церебральной и соматической оксиметрии. Этот метод представляется полезным как при анестезии, так и в отделениях интенсивной терапии. Однако в настоящее время недостаточно клинических данных о критических уровнях измеряемых переменных, которые необходимы для безопасного ведения периоперационного периода у восприимчивых к церебральной ишемии пациентов, в частности в педиатрии.

Особенности показателей церебральной оксиметрии при различных видах комбинированной анестезии у детей с врожденной хирургической патологией

Актуальность. В последнее десятилетие ближняя инфракрасная спектроскопия приобрела популярность в отделениях новорожденных. С учетом современного международного опыта в представленной работе проведена оценка особенностей церебральной оксиметрии у детей с врожденными пороками развития хирургического профиля при различных видах комбинированной анестезии. Цель исследования: оценить состояние церебральной оксигенации у новорожденных и младенцев с врожденными пороками развития при различных видах анестезиологического сопровождения. Материалы и методы. В ретроспективное исследование были включены 150 новорожденных и младенцев с врожденными пороками развития хирургического профиля в зависимости от анестезии (ингаляционное + региональное; ингаляционное + внутривенное и тотальное внутривенное обезболивание). Анализировались показатели церебральной оксиметрии по сравнению с показателями периферической сатурации, артериального давления, парциального напряжения СО2, О2 в крови, рН. Результаты. Минимальный показатель церебральной оксиметрии отмечен с левого полушария мозга у детей I группы — 50,57 ± 16,66, что может быть неблагоприятным прогностическим фактором в дальнейшем восстановлении и влиянии на когнитивные функции головного мозга ребенка. Через 1 час после операции дети I группы, получавшие комбинированную анестезию севораном с региональным обезболиванием, демонстрировали худшие показатели церебральной оксиметрии по сравнению с детьми II и III групп (rSO2 правого полушария в I группе — 56,84 ± 12,27, rSO2 левого полушария в I группе — 57,53 ± 13,32, р = 0,0001; 0,0028), в то время как различия в показателях II и III групп не выявлены (р = 0,4167; 0,4029). Выводы. Ближняя параинфракрасная спектрометрия зарекомендовала себя как простой, целесообразный и полезный метод контроля за состоянием насыщенности кислородом головного мозга. При выборе комбинированной анестезии ингаляционным методом с региональным обезболиванием у детей с врожденными пороками развития для проведения оперативного лечения следует более тщательно контролировать церебральную оксигенацию с дополнительным контролем периферической сатурации, артериального давления, парциального напряжения СО2, О2 в крови и рН.

Retinal vessel oximetry in children with inherited retinal diseases.

Retinal vessel oximetry (RO) has been used to show altered metabolic function in patients with inherited retinal diseases (IRDs). The aim of this study was to investigate RO parameters of children with IRDs and presumed IRD carriers (pIRDc) and to compare them to controls. In this cross-sectional cohort study, 142 eyes from 71 Caucasian subjects were included: 40 eyes with IRDs, 26 eyes with pIRDc and 76 control eyes. The oxygen saturation was measured with the Retinal Vessel Analyser (IMEDOS Systems UG, Jena, Germany). Mean oxygen saturations in the peripapillary retinal arterioles (A-SO2 ; %) and venules (V-SO2 ; %) were estimated, and their difference (A-V SO2 ; %) was calculated. In addition, we evaluated the mean diameter in all major retinal arterioles (D-A; μm) and venules (D-V; μm). anova-based linear mixed-effects models were calculated with SPSS® . In general, children suffering from IRDs differed from controls when the A-SO2 and A-V SO2 were taken into account: both the A-SO2 and the A-V SO2 were significantly increased (p=0.012). In subgroup analyses, children suffering from rod-cone dystrophy (RCD) presented an A-SO2 increase (99.12±8.24%) when compared to controls (91.33±10.34%, p=0.014) and pIRDc (92.37±6.57%, p=0.065). For V-SO2 significant changes in RCD (67.42±9.19%) were found in comparison with controls (58.24±11.74%, p<0.041), pIRDc (56.67±7.16%, p=0.007), cone-rod dystrophies (CRD, 52.17±5.32%, p<0.001) and inherited macular dystrophies (IMD, 55.74±6.96%, p=0.004), In addition, A-V SO2 was decreased in RCD (31.69±3.92%) when measured against CRD (41.9±8.87%, p=0.017) or IMD (39.52±8.95%, p=0.059). In general, we found that children with IRDs presented early metabolic changes. Within IRDs, children with RCD showed more affected metabolic changes. Thus, RO may support early screening to rule out IRDs in children, and more precisely may help to differentiate those suffering from RCD.

The McGill score as a screening test for obstructive sleep disordered breathing in children with co-morbidities

BackgroundThe McGill score is used to stratify severity of oximetry in children referred for investigation of obstructive sleep apnoea (OSA) to identify those with more severe disease and prioritize treatment. We hypothesized that its positive predictive value (PPV) and negative predictive value (NPV) in detecting OSA differs significantly between children with medical conditions and otherwise healthy children. MethodsWe performed a two-year retrospective analysis of children referred for investigation of OSA who underwent a cardiorespiratory (CR) polygraphy study. McGill score was calculated from the oximetry trace blinded to polygraphy results. We looked at two definitions of OSA: Obstructive Apnoea Hypopnoea Index (oAHI) ≥1 and ≥ 5. McGill sensitivity, specificity, PPV and NPV were calculated. McGill score = 1 was considered normal or inconclusive, >1 abnormal. ResultsWe studied 312 children, 190 males (61%), median age 4.5 (2.4–7.9) years. 129 were otherwise healthy and 183 had associated medical conditions. The PPV of the McGill score was significantly lower in children with medical conditions than otherwise healthy children. The NPV was similar in both groups of children. ConclusionsThe higher number of false positives in children with medical conditions may be due to non-obstructive causes such as central apnoeas. Children with underlying lung disease are also more likely to desaturate following a brief apnoea or hypopnoea. Children with co-morbidities who have an abnormal McGill score should not be assumed to have OSA and need more detailed sleep studies to determine the reason for the oxygen desaturations.

Retinal vessel oximetry in children with inherited retinal diseases

AbstractBackgroundAlterations in retinal oxygen metabolism have already been confirmed in eldery subjects with retinitis pigmentosa (RP). Hovewer, whether this is a also a feature in children affected by RP has not been studied yet. The aim of our study was to compare retinal oxymetry (RO) parameters whithin children with inherited retinal diseases (IRDs), as well as agains those of carriers and healthy controls.MethodsA total of 68 children (136 eyes) of were examined: 16 with IRDs (32 eyes) were compared to those of 11 IRD carriers (22 eyes) and of 41 healthy children (82 eyes). RO was performed with the oxygen saturation tool of the Retinal Vessel Analyser (RVA; IMEDOS, Germany). The mean oxygen saturations, within 1.0–1.5 optic disc diameters from the disc margin, in the retinal arterioles (A‐SO2;%) and venules (V‐SO2;%) were estimated and their difference (A‐V SO2;%), was calculated. The corresponding arterioles (D‐A;μm) and venules (D‐V;μm) were evaluated, as well. For statistical evaluation ANOVA‐based linear mixed‐effects models were calculated with SPSS®.ResultsThe V‐SO2 showed a statistically significant increase in RP eyes (67.00 ± 7.48%) when compared to healthy controls (59.07 ± 11.98%, p=0.03), but also to children with other IRDs and to carriers (p ≤ 0.03). The A‐V SO2 showed a statistically significant decrease in RP eyes (32.62 ± 4.03%), when compared to eyes suffering from macular dystrophies (MD, 44.35 ± 10.55%, p = 0.05) or cone‐rod‐dystrophies (CRD, 43.29 ± 10.55, p = 0.03). The D‐V, even if not reaching statistically significant level, showed a trend for RP to be slightly attenuated (102.31 ± 8.20 μm) when compared to controls (108.76 ± 20.87 μm; p = 0.07).ConclusionThese data indicate that children suffering RP show early metabolic alterations. With aging and progression of RP the sign of vascular attenuation seems to be a secondary effect of neurovascular remodeling. Here, RO seems to be a useful screening tool for metabolic dysfunction within a family affected from RP.

Nocturnal oximetry in children with obstructive lung disease or sleep-disordered breathing.

Although progress has been made in the standardized interpretation of nocturnal oximetry in children with obstructive sleep-disordered breathing (SDB), no evidence exists on oximetry abnormalities in other respiratory disorders. We aimed to compare obstructive lung disease (OLD) and SDB regarding nocturnal oximetry parameters. We analyzed oximetry recordings from children with (i) OLD (obliterative bronchiolitis; cystic fibrosis); (ii) snoring and adenotonsillar hypertrophy (SDB); and (iii) no respiratory disorder (controls). The three groups were compared regarding: (i) oxygen desaturation of hemoglobin index (SpO2 drops ≥3%/h-ODI3) and (ii) basal SpO2 (average SpO2 between SpO2 drops). The associations of oximetry parameters (natural logarithm) with study group were tested using linear regression including age as covariate. Data of 16 subjects with OLD (median age: 7.3 years; Q25, Q75: 5.4, 12), 22 children with SDB (6.3 years; 4, 9) and 22 controls (6.8 years; 5.6, 10.3) were analyzed. Children with OLD or SDB had significantly lower basal SpO2 than controls (91.9% [90.8, 93.4] vs 96.3% [96, 97.4] vs 97.6% [97.1, 97.9]; P < 0.01). No subjects in the SDB or control groups had basal SpO2 < 95%. Children with SDB had significantly higher ODI3 than children with OLD or controls [8.4 episodes/h (6.2, 16.6) vs 4.4 episodes/h (3.6, 6.6) vs 2 episodes/h (1.3, 2.7); P < 0.01]. OLD had the greatest negative effect on basal SpO2 (R2 = 0.62; P < 0.001) and SDB the greatest positive effect on ODI3 (R2 = 0.34; P < 0.001). OLD is associated mostly with reduced basal SpO2 , whereas SDB is characterized by elevated ODI3.

Overnight oximetry in children undergoing adenotonsillectomy: a single center experience

BackgroundObstructive sleep apnea (OSA) is the most common indication for adenotonsillectomy in children. Home-based sleep oximetry continues to be used in the diagnosis of pediatric OSA despite a lack of correlation with lab-based polysomnography. This study investigates whether factors influence surgeons in selecting patients for home-based sleep oximetry, how the study findings are used in patient management, and whether abnormal oximetry findings are associated with post-operative complications.MethodsA retrospective review was performed on children with suspected OSA who had undergone a tonsillectomy and/or an adenoidectomy over a three-year period. Demographic features, comorbidities, pre-operative oximetry results, and post-operative complications were recorded. Data analysis consisting primarily of logistic regression was performed using Stata 12.0 (College Station, Texas).ResultsData was collected from 389 children. Two hundred and seventy-one children underwent pre-operative oximetry (69.7%). There was no significant association between age or the presence of comorbidities and the likelihood of undergoing pre-operative sleep oximetry. The post-operative complication rate was 0.8%. There was no significant association between abnormal sleep oximetry parameters and post-operative complications. Children with one or more abnormal sleep oximetry parameters were more likely to be observed in hospital for at least one night (OR 2.4, p < 0.0001).ConclusionsOur study suggests that surgeons are using home-based sleep oximetry findings to inform the post-operative care of children with suspected OSA, as those with abnormal home-based sleep oximetry findings were more likely to be observed in hospital. These hospital admissions may be unnecessary given the poor correlation of home-based oximetry and PSG as well as the low rate of serious post-operative complications.

Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis.

ObjectiveThe purpose of the study was to investigate parental preference of continuous pulse oximetry in infants and children with bronchiolitis.Materials and methodsA cross-sectional prospective study was conducted at Hamad Medical Corporation in Qatar. Parents of infants and children <24 months old and hospitalized with bronchiolitis were offered an interview survey.ResultsA total of 132 questionnaires were completed (response rate 100%). Approximately 90% of participants were 20–40 years of age, and 85% were females. The mean age of children was 7.2±5.8 months. Approximately eight in ten parents supported the idea of continuous pulse oximetry in children with bronchiolitis. Almost 43% of parents believed that continuous pulse-oximetry monitoring would delay their children’s hospital discharge. Interestingly, approximately 85% of caregivers agreed that continuous pulse oximetry had a good impact on their children’s health. In addition, around one in two of the participants stated that good bedside examinations can obviate the need for continuous pulse oximetry. Furthermore, 80% of parents believed that continuous pulse-oximetry monitoring would give the health-care provider a good sense of security regarding the child’s health. Finally, being a male parent was associated with significantly increased risk of reporting unnecessary fatigue, attributed to the sound of continuous pulse oximetry (P=0.031).ConclusionContinuous pulse-oximetry monitoring in children with bronchiolitis was perceived as reassuring for parents. Involving parents in decision-making is considered essential in the better management of children with bronchiolitis or any other disease. The first step to decrease continuous pulse oximetry will require provider education and change as well. Furthermore, we recommend proper counseling for parents, emphasizing that medical technology is not always essential, but is a complementary mode of managing a disease.

Age and seasons influence on at-home pulse oximetry results in children evaluated for suspected obstructive sleep apnea

BackgroundSeasonal variability on obstructive sleep apnea has already been studied by polysomnography in children. Winter and spring season emerged as critical periods. No data are currently available for pulse oximetry performed at home. The aim of our study was to evaluate the effect of seasonality and age on the results of at-home pulse oximetry performed in children referred for suspected OSA.MethodsWe retrospectively studied 781 children (64.3% Males), aged 4.9 ± 2.5 years. For all patients, we evaluated both pulse oximetry metrics and the McGill Oximetry Score. Variables for seasonal groups were assessed using Kruskal-Wallis test. A logistic regression model was performed to assess the relationship between patients’ main characteristics, season period and the likelihood to have an abnormal McGill Oximetry Score.ResultsPatients recorded during winter were significantly younger (p < 0.02), nadir SpO2 was significantly lower (p < 0.002) and DI4 significantly higher than during others seasons (p < 0.005). Moreover, patients recorded during winter were nearly 2 times more likely to have an abnormal MOS (aOR 1.949). The logistic regression showed that also younger age (p < 0.0001) was associated with a higher risk to find an abnormal pulse oximetry.ConclusionsIn our study, the winter season confirms to be a critical period for pulse-oximetry and it should be taken into account by clinicians for a correct interpretation of tests. Our data show that also younger age affects the prevalence of abnormal at-home pulse oximetry in children.

At-home pulse oximetry in children undergoing adenotonsillectomy for obstructive sleep apnea.

In our study, children with OSA who subsequently needed T&A showed higher PRV compared to those without surgical indication. Children with abnormal MOS were nearly 20 times more likely to undergo T&A. What is Known: • Nocturnal pulse oximetry has a high positive predictive value for polysomnographically diagnosed obstructive sleep apnoea in children. • When significant adenotonsillar hypertrophy is diagnosed, adenotonsillectomy represents a common treatment for OSA in children. What is New: • An abnormal pulse oximetry highly predict the indication for adenotonsillectomy. • We suggest the use of at-home pulse oximetry as method to predict prescription of adenotonsillectomy, and this may be useful in contexts where polysomnography is not readily available.

How Should Oxygen Supplementation Be Guided by Pulse Oximetry in Children: Do We Know the Level?

Supplemental oxygen is one of the most commonly prescribed therapies to children in hospital, but one of the least studied therapeutics. This review considers oxygen from a range of perspectives; discovery and early use; estimation of oxygenation in the human body—both clinically and by medical device; the effects of illness on oxygen utilization; the cellular consequences of low oxygen; and finally, how clinical studies currently inform our approach to targeting supplementing oxygen in those with lower than normal oxygen saturation.

Night-to-night variation of pulse oximetry in children with sleep-disordered breathing

BackgroundSleep-disordered breathing is a common and serious feature of many paediatric conditions and is particularly a problem in children with Down syndrome. Overnight pulse oximetry is recommended as an initial...

Accuracy of pulse oximetry versus arterial blood gas in screening cyanotic heart

Background: A study was planned To determine the performance and accuracy of pulse oximetry in children with cyanotic heart diseases compared with arterial oxygen saturation measurements from arterial blood gas analysis and to use transcutaneous pulse oximeter as the first line of non-invasive investigation to diagnose cyanotic heart diseases in peripheral and rural health facilities where echocardiography may not be readily available. Methods: This was a prospective observational study conducted in Safdarjung Hospital. Children with cyanotic congenital heart disease were enrolled the data was analyzed by using PASW Statistics version 19.0 (SPSS Inc., Chicago, IL, US). Frequency and percentage was calculated for categorical variables. Mean and standard deviation was calculated for continuous variables. Chi‑square test and Fisher’s exact test was used to compare categorical variables. Correlation was assessed between ABG and SpO2. Results: A total number of 40 children were enrolled. There was a significant correlation between transcutaneous oxygen saturations and arterial oxygen saturation statistically. Conclusions: The pulse oximeter detected oxygen saturation comparable to arterial oxygen saturation in all the patients with cyanotic heart diseases, even though most of them did not present with clinically significant cyanosis.

Improving detection of obstructive sleep apnoea by overnight oximetry in children using pulse rate parameters.

Overnight oximetry is a simple tool for investigation of obstructive sleep apnoea (OSA) in children, but only severe cases will be detected, and children with obstructive events resulting in arousal, but not desaturation, will have a normal (inconclusive) result. We hypothesised that pulse rate rises using pulse rate indices per hour (PRI) and pulse rate standard deviation (PR-SD) automatically calculated from commercially available software would improve oximetry as a diagnostic tool. Children having home overnight oximetry for suspected OSA were identified over 12months, and those with a normal result who went on to have polysomnography (PSG) were included. Oximetry, including PR-SD and PRI (rises of 8, 10 and 15 beats/min per hour), was analyzed using commercially available software. PR parameters were compared between those with OSA (obstructive apnoea-hypopnoea index (OAHI) >1 event/h) and those without OSA. One hundred sixteen children had normal oximetry, of whom 93 (median age 4.5years; 55%M) had PSG. Fifty-seven of 93 (61%) children had OSA (median OAHI 4.5 events/h, range 1.1-24). PR-SD was not different between the OSA and non-OSA groups (p = 0.87). PRI tended to be higher in those with OSA, but there was considerable overlap between the groups: PRI-8 (mean ± SD 58.5 ± 29.0/h in OSA group vs 48.6 ± 20.2/h in non-OSA group, p = 0.07), PRI-10 (45.1 ± 25.0 vs 36.2 ± 16.7, p = 0.06) and PRI-15 (24.4 ± 14.5 vs 18.9 ± 9.0, p = 0.04). A PRI-15 threshold of >35/h had specificity of 97% for OSA. The PRI-15 shows promise as an indicator of OSA in children with normal oximetry.

136 Nocturnal oximetry in children with cystic fibrosis (CF)

136 Nocturnal oximetry in children with cystic fibrosis (CF)