Postductal SpO2 Research Articles

Intact cord resuscitation in newborns with congenital diaphragmatic hernia: insights from a lamb model.

Congenital diaphragmatic hernia (CDH) is a rare condition characterized by pulmonary hypoplasia, vascular dystrophy, and pulmonary hypertension at birth. Validation of the lamb model as an accurate representation of human CDH is essential to translating research findings into clinical practice and understanding disease mechanisms. This article emphasizes the importance of validating the lamb model to study CDH pathogenesis and develop innovative therapeutics. At 78 days of gestation, the fetal lamb's left forelimb was exposed through a midline laparotomy and hysterotomy, and a supra diaphragmatic thoracotomy was performed to allow the digestive organs to ascend into the thoracic cavity. At 138 ± 3 days of gestation, lambs were delivered via a cesarean section; then, with umbilical cord intact during 1 hour, the lambs were mechanically ventilated with gentle ventilation in a pressure-controlled mode for 2 h. CDH lambs exhibited a lower left lung-to-body weight ratio of 5.3 (2.03), p < 0.05, and right lung-to-body weight ratio of 8.2 (3.1), p < 0.05. They reached lower Vt/kg (tidal volume per kg) during the course of the resuscitation period with 1.2 (0.7) ml/kg at 10 min and 3 (1.65) ml/kg at 60 min (p < 0.05). Compliance of the respiratory system was lower in CDH lambs with 0.5 (0.3) ml/cmH2O at 60 min (p < 0.05) and 0.9 (0.26) ml/cmH2O at 120 min (p < 0.05). Differences between pre- and postductal SpO2 were higher with 15.1% (21.4%) at 20 min and 6.7% (14.5%) at 80 min (p < 0.05). CDH lambs had lower differences between inspired and expired oxygen fractions with 4.55% (6.84%) at 20 min and 6.72% (8.57%) at 60 min (p < 0.05). CDH lamb had lower left ventricle [2.73 (0.5) g/kg, p < 0.05] and lower right ventricle [0.69 (0.8), p < 0.05] to left ventricle ratio. CDH lambs had significantly lower tidal volume than control lambs due to lower compliance of the respiratory system and higher airway resistance. These respiratory changes are characteristic of CDH infants and are associated with higher mortality rates. CDH lambs also exhibited pulmonary hypertension, pulmonary hypoplasia, and left ventricle hypoplasia, consistent with observations in human newborns. To conclude, our lamb model successfully provides a reliable representation of CDH and can be used to study its pathophysiology and potential interventions.

Role of Pulse Oximetry as a Screening Tool for the Detection of Congenital Heart Disease in Newborn Babies

Background: Congenital heart disease (CHD) is one of the commonly seen malformations, with incidence varying from 7 to 8/1000 live birth. Causes are multifactorial. Routine examination of neonates may miss more than 50% of cases. Pulse oximetry is a simple, noninvasive, bedside test which estimates the percentage of oxygen bound to hemoglobin (oxygen saturation [SpO2]). Detection of critical CHD (CCHD) has been possible with SpO2 screening. Many countries included SpO2 as part of newborn screening due to this. As a primary approach, both pre- and post-ductal extremity SpO2 is measured after 24 h of life. Echocardiography (ECHO) will be done on neonates with SpO2 readings &lt;95%. Neonates born in high-altitude regions, studies have suggest to use adjusted threshold values. In India, there are limited studies. Aims: The aim of this study was to determine the usefulness of pulse oximetry as a screening tool for early detection of CHD in otherwise asymptomatic newborns. To determine, the accuracy of SpO2 for detecting clinically unrecognized CCHD in newborns. Materials and Methods: This is a prospective observational study done in the department of pediatrics in a tertiary hospital. The study was conducted over 12 months. During the study period, all neonates born who fulfilled the inclusion criteria were included in the study. After 24 h of life, neonates were examined clinically and the pre- and post-ductal SpO2 was measured. Neonates with SpO2 &lt;90% in room air were excluded from the study. If the SpO2 was between 90% and 94%, clinical examination was repeated, if suspicious of CHD, they were referred for ECHO. If there was no suspicion of CHD, SpO2 was repeated after 6 h and ECHO was done if SpO2 ≤95. The difference of SpO2 &gt;3% between the right upper limb and right lower limb was considered positive. Positive neonates were evaluated with two-dimensional echocardiograph. Inclusion criteria - All hemodynamically stable neonates were born during the study period. Exclusion criteria (1) Antenatally diagnosed cardiac anomalies, (2) Outborn neonates, (3) Parents/guardians are not willing to participate in the study and/or further investigation, (4) Sick neonates and those with SpO2 &lt;90% at birth. Results: 1117 (83.7%) were eligible for the study out of 1333 neonates born. 669 (59.9%) were born by cesarean section and 448 (40.1%) by vaginal delivery. 996 (89.2%) were born at term (≥37 weeks of gestation) and 121 (10.8%) were preterm (&lt;37 weeks of gestation). The male-to-female ratio was 1.03:1. The mean birth weight of the neonates was 2.91 ± 0.46 kg (mean ± standard deviation). The mean SPO2 in the right upper limb was 96.62 ± 1.73, in the right lower limb was 96.87 ± 1.76, in the left upper limb was 96.59 ± 1.90, and in the left lower limb was 97.06 ± 1.74. The average SPO2 difference between the right upper limb and right lower limb was 1.04 ± 1.07. Based on SpO2, 858 (76.8%) cases were not suspected of having CHD and 259 (23.3%) were suspected of having CHD and were evaluated with ECHO. Six (0.5%) neonates had CHD in whom echo was done. In our study, for detecting CCHD, SPO2 cutoff value of ≤90% showed 90% sensitivity, 99.94% specificity, 75% positive predictive value, and 99.98% negative predictive value. Conclusions: This study emphasizes noninvasive SPO2 as reliable and feasible, with good negative predictive value screening for CHD in neonates.

Preductal postductal oxygen saturation gradient in preterm infants immediately after birth: Effect of gestational age on achievement of target saturation

Background: The delivery room oxygen saturation (SpO2) monitoring in neonates is based on studies in term infants. Study of preductal-postductal SpO2 gradient in healthy preterms immediately after birth will help in follow-up of an abnormal gradient, rationalizing oxygen therapy, and early identification of congenital cyanotic heart disease. Aims and Objectives: SpO2 is initially low and gradually increases to normal in healthy term newborns postnatally. Postductal SpO2 is lower than preductal, but their difference gradually decreases postnatally. Our study aims to find out the preductal-postductal SpO2 gradient in healthy preterms and the correlation between gestational age and SpO2. In preterms, gradient may persist longer due to patent ductus arteriosus and higher pulmonary vascular resistance. Materials and Methods: This observational cross-sectional study has been conducted over 1 year with 80 preterms immediately after birth, after the Institutional Ethics Committee approval and parental informed consent. Preductal and postductal SpO2 were recorded by probes on right hand and left foot respectively for 20 min after birth. Data were analyzed by SPSS software. Results: This study shows that preductal-postductal SpO2 gradient is significant in the first 20 min of life in preterms, and there is significant positive correlation of gestational age with preductal SpO2 at 1 min and negative correlation of gestational age with time taken to achieve 90% SpO2. Conclusion: This study concludes that significant preductal-postductal SpO2 gradient persists for first 20 min of life in preterms and preductal SpO2 at 1 min decreases and time taken to reach SpO2 90% increases significantly with decreasing gestational age.

Trajectories of oxygen saturation within 6–72 hours after birth in neonates at moderate altitude: a prospective longitudinal cohort study

BackgroundTrajectories of pulse oxygen saturation (SpO2) within the first few days after birth are important to inform the strategy for identifying asymptomatic hypoxemic disease but remain poorly substantiated at higher altitudes.MethodsWe performed a longitudinal cohort study with consecutive neonates at a local hospital in Luchun County, China, at an altitude of 1650 m between January and July 2020. We repeatedly measured the pre- and post-ductal SpO2 values at 6, 12, 18, 24, 36, 48, and 72 hours after birth for neonates without oxygen supplements. All neonates underwent echocardiography and were followed up to 42 days after discharge. We included neonates without hypoxemic diseases to characterize the trajectories of SpO2 over time using a linear mixed model. We considered the 2.5th percentile as the reference value to define hypoxemic conditions.ResultsA total of 1061 neonates were enrolled. Twenty-five had non-cardiac hypoxemic diseases, with 84% (21/25) presenting with abnormal SpO2 within 24 hours. One had tetralogy of Fallot identified by echocardiography. Among the 1035 asymptomatic neonates, SpO2 values declined from 6 hours after birth, reached a nadir at 48 hours, and tended to level off thereafter, with identical patterns for both pre- and post-ductal SpO2. The reference percentile was 92% for both pre- and post-ductal SpO2 and was time independent.ConclusionsA decline within 48 hours features SpO2 trajectories within the first 72 hours at moderate altitude. Our findings suggest that earlier screening may favorably achieve a benefit–risk balance in identifying asymptomatic hypoxemic diseases in this population.

Pattern of Congenital Heart Diseases among Term and Preterm Neonates in a Tertiary Care Hospital of a Developing Country

Objective: To determine the frequency and pattern of various congenital heart diseases in a tertiary care hospital neonatal unit.&#x0D; Study Design: Prospective longitudinal study.&#x0D; Place and Duration of Study: Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan from Jul 2015 to Jun 2018.&#x0D; Methodology: All neonates admitted to the Neonatal Unit of Pak Emirates Military Hospital, Rawalpindi Pakistan, suspected of having congenital heart disease were included in the study. Suspicion for CHD was based on the presence of murmur, cyanosis with or without feeding difficulty, signs of congestive heart failure, and variation in pre and post-ductal SpO2 reading. Echocardiography was performed on all neonates by a Paediatric cardiologist to determine diagnosis and type of lesion.&#x0D; Results: One hundred and thirty-one neonates were found to have congenital heart disease with male predominance, with 79(60.3%) males and 52(39.7%) females. Ventricular Septal Defect (VSD) was the most common lesion occurring in 44(33.6%) neonates, followed by PDA in 28(21.37%) neonates. CHD occurred more frequently in term neonates (62.0%) than preterm neonates (38.0%).&#x0D; Conclusion: Congenital heart disease is the most common congenital malformation, with Asia having the highest prevalence worldwide. Lack of specialized antenatal and neonatal health services and paucity of diagnostic facilities lead to delays in diagnosis, increasing morbidity and mortality of CHD cases. Therefore, drastic measures are required to improve neonatal health and transport facilities in our country to mitigate the impact of this disease.

Use of Pulse Oximetry Pulsatility Index Screening for Critical Congenital Heart Disease.

This study aimed to compare oximetry data (pre- and postductal oxygen saturation [SpO2], pre- and postductal pulsatility index [PI]) in healthy newborns (≥35 weeks' gestational age) to infants who have critical congenital heart disease (CCHD). This is a retrospective analysis of data obtained from electronic medical records, recorded as part of routine pulse oximetry screening (POS) for CCHD in infants born between the years 2013 and 2020. Testing was performed at 24 ± 2 hours of life. Data were analyzed to detect differences in pre- and postductal SpO2 and pre- and postductal PI in healthy newborns compared with infants who have CCHD. Newborns were excluded from analysis if they: (1) had a prenatal diagnosis of CCHD in the medical record, (2) had previously been admitted to the neonatal intensive care unit, or (3) had failed POS but were found no CCHD by diagnostic echocardiography. A total of 88,754 healthy newborns had received POS between the years 2013 and 2020. Of the 88,736 newborn records available for analysis,18 newborns were diagnosed with CCHD. Eight were identified by POS before discharge and 10 were diagnosed after discharge. Infants diagnosed with CCHD by POS had lower pre- and postductal SpO2 compared with normal infants. Their postductal PI was significantly lower. Infants who had CCHD that was not identified by POS had similar pre- and postductal SpO2 values, but their postductal PI was lower. Using a postductal PI cutoff of 1.21 had a receiver operating curve of area under the curve 0.77 (95% confidence interval: 0.672, 0.869) with 74% sensitivity and 61% specificity. In our large cohort of infants born in San Diego County, the postductal PI is lower in infants with CCHD. Given that PI is routinely displayed on every pulse oximeter and the high morbidity of missed CCHD, PI should be incorporated into routine CCHD screening. · Postductal PI is lower in newborn who presented later with congenital heart disease.. · Postductal PI cut-off of 1.21 may help practitioners determine if a newborn is at risk for CCHD.. · This large cohort study demonstrates that a low PI can detect additional CCHD cases..

The Use of Modified High Flow Nasal Cannula (HFNC) In Preterm Infants With Neonatal Respiratory Distress Syndrome (NRSD) In Primary ICU Services

Introduction: NRSD (Neonatal Respiratory Distress Syndrome) is one of the most frequent causes of newborns in intensive care (NICU). Several NICU centers are now using the High Flow Nasal Cannula (HFNC) in recent years. With the use of HFNC as a breath aid in preterm infants, HFNC had the same efficacy ratio as nasal Continuous Positive Airway Pressure (CPAP) (continuous or intermittent). Case Report: A three-day-old baby boy was admitted to anesthesia with respiratory failure due to grade II HMD with suspicion of congenital heart failure. The initial condition showed that a respiratory rate of 70-80x / minute, breathing of the nostrils and retractions in the intercostals and abdomen with 85% post ductal SpO2 with the help of a CPAP mask (Pinsp 10, Fio2 70%). There was a Ronchi sound in the right and left basal lungs, and hemodynamics obtained a pulse of 180-195x / minute, non-invasive blood pressure 95/34 mmHg (54), heart murmurs were not found. During day 1 - day three, the patient uses a CPAP mask until the patient vomits and being consulted to an Anesthesiologist. On day 3 - day seven, the patient uses HFNC; after day seven until day 10, the patient uses neonatal nasal canularis oxygen. Until day 10, the patient is still being treated at the NICU by administering oxygen 0.5 liters/minute with SpO2 ranging from 93-96% with stable conditions but still needing oxygen. Conclusion: The use of Modified High Flow Nasal Cannula (HFNC) in preterm infants with Neonatal Respiratory Distress Syndrome (NRSD) is more effective and efficient than CPAP. The use of HFNC was associated with a lower incidence of nasal trauma and pneumothorax than nasal CPAP.

Near infrared spectroscopy and abdominal compartmental syndrome in neonates

ABSTRACT Background and Aims Abdominal compartmental syndrome considered the most common cause of postoperative mortality in neonates scheduled for surgical repair of congenital abdominal wall defect. This study aimed primarily to observe the renal and cerebral rSO2 variation during and after surgical reduction, while secondarily to analyze correlations with other perfusion markers of intra-abdominal hypertension. Patients and methods A randomized, prospective, cohort study was piloted in a tertiary care pediatric surgery center from February 2017 to march 2021 where 20 neonates scheduled surgical repair of congenital abdominal wall defects. Near-infrared spectroscopy (NIRS) measurements of regional tissue oxygenation (rSO2) fluctuations performed using the two-channel mode, channel 1 for cerebral monitoring (C rSO2) and channel 2 for renal monitoring (R rSO2), and calculating differences intraoperative as well as postoperative. Results Intra-operative C and R ΔrSO2 had a significant positive correlation with an intraoperative post-ductal SPO2 and MABP changes, while a significant negative correlation was noted with serum lactate level and capillary refill time. Postoperative C ΔrSO2 showed a negative correlation with postoperative serum lactate level, whereas postoperative R ΔrSO2 had a positive correlation with postoperative post-ductal SPO2 changes, and negative correlations with postoperative capillary refill time changes. Pathological intraoperative ΔrSO2 had a statistically significant relation with intraoperative post-ductal SPO2, MABP, capillary refill time, serum lactate level, postoperative serum creatinine level, and postoperative vasoactive-ventilation-renal (VVR) score. Conclusion : NIRS is an efficient non-invasive monitor of cerebral and tissue perfusion, evaluating tissue microcirculation, and considered an early warning for detecting abdominal compartment syndrome (ACS) in neonates.

Prostaglandin E1 in infants with congenital diaphragmatic hernia (CDH) and life-threatening pulmonary hypertension

BackgroundSuprasystemic pulmonary hypertension (PH) is highly predictive of pulmonary morbidity and death in infants with congenital diaphragmatic hernia (CDH). ObjectivesTo report the effects and tolerability of Prostaglandin E1 (PGE1) in newborns with severe CDH and life-threatening PH. MethodsNewborn infants with isolated CDH and life-threatening PH defined by an acute worsening of the cardiorespiratory function, and bidirectional or exclusive right-to-left shunting across the ductus arteriosus (DA) with an acceleration of the blood flow >1.5 m.s−1 assessed by Doppler echocardiography. Serial measurements of cardiorespiratory variables have been recorded before and after PGE1. Results18 infants (out of 102 in the cohort) were included in the study (gestational age: 39 ± 2 weeks). The median FiO2, and preductal and postductal SpO2 were 80% [50; 100], 91% [88; 95] and 86% [82; 91], respectively, before treatment. FiO2 decreased to 35% [30–40] (p = 0.001) at H6. Maximal blood flow velocities in the DA decreased after starting PGE1 from 2.2 m.s−1 [1.5–2.5] to 1 m.s−1 [0.55–1.2] (p < 0.001). ConclusionsPGE1 treatment improved oxygenation and circulatory function in newborn infants with severe CDH and life-threatening PH. Our data provide evidence that restrictive DA may result in suprasystemic pulmonary hypertension in CDH infants, and that PGE1 may improve cardiorespiratory failure through reopening of the DA. Type of studyTreatment study. Level of evidenceLevel III.

Revised threshold values for neonatal oxygen saturation at mild and moderate altitudes.

The aim of this study was to determine reference values for oxygen saturation (SpO2 ) in neonates at mild and moderate altitudes. Our study included 41097 consecutively born, asymptomatic neonates from 35 hospitals, located in Yunnan, China, with altitudes ranging from 267 to 2202m. Pre-and post-ductal SpO2 of each neonate was measured at 24hours of age and before hospital discharge. All study participants, according to the altitude of birth, were categorised into three groups: low (0-500m), mild (500-1500m) and moderate altitude (1500-2500m). Every 1000-m increase in altitude was associated with a 1.54 per cent decrease in mean SpO2 . The means of pre-ductal SpO2 at low, mild and moderate groups were 97.9%, 96.4% and 95.5%, respectively. We used the 2.5th percentile of SpO2 distribution as the cut-off for neonatal SpO2 screening and defined new cut-off values of ≤93% for mild altitudes, ≤92% for moderate altitudes and no adjustment for low altitudes. We recommend revised cut-off values for neonatal SpO2 at mild and moderate altitudes and provide new values for paediatricians to refer to when screening neonates for severe congenital heart or lung diseases.

Accuracy of Pulse Oximetry Screening for Critical Congenital Heart Defects after Home Birth and Early Postnatal Discharge

To assess the accuracy of pulse oximetry screening for critical congenital heart defects (CCHDs) in a setting with home births and early discharge after hospital deliveries, by using an adapted protocol fitting the work patterns of community midwives. Pre- and postductal oxygen saturations (SpO2) were measured ≥1 hour after birth and on day 2 or 3. Screenings were positive if the SpO2 measurement was <90% or if 2 independent measures of pre- and postductal SpO2 were <95% and/or the pre-/postductal difference was >3%. Positive screenings were referred for pediatric assessment. Primary outcomes were sensitivity, specificity, and false-positive rate of pulse oximetry screening for CCHD. Secondary outcome was detection of noncardiac illnesses. The prenatal detection rate of CCHDs was 73%. After we excluded these cases and symptomatic CCHDs presenting immediately after birth, 23 959 newborns were screened. Pulse oximetry screening sensitivity in the remaining cohort was 50.0% (95% CI 23.7-76.3) and specificity was 99.1% (95% CI 99.0-99.2). Pulse oximetry screening was false positive for CCHDs in 221 infants, of whom 61% (134) had noncardiac illnesses, including infections (31) and respiratory pathology (88). Pulse oximetry screening did not detect left-heart obstructive CCHDs. Including cases with prenatally detected CCHDs increased the sensitivity to 70.2% (95% CI 56.0-81.4). Pulse oximetry screening adapted for perinatal care in home births and early postdelivery hospital discharge assisted the diagnosis of CCHDs before signs of cardiovascular collapse. High prenatal detection led to a moderate sensitivity of pulse oximetry screening. The screening also detected noncardiac illnesses in 0.6% of all infants, including infections and respiratory morbidity, which led to early recognition and referral for treatment.

Critical congenital heart disease screening with a pulse oximetry in neonates.

To compare the results of pulse oximetry screening for critical congenital heart disease (CCHD) in newborn infants performed at <24 h and >24 h following. Measurements were taken for each group at <24 h and >24 h following birth. Echocardiography was performed if the SpO2 readings remained abnormal results. A total of 4518 newborns were included in this prospective descriptive study. Of these, 2484 (60.3%) were delivered vaginally and 1685 (39.7%) by cesarean section. Median time points of the screening were 25.4 (25.3-25.5) vs. 17.3 (12.2-22.4) hours after birth. In 4109 infants screened 24 h after birth, the mean pre- and postductal oxygen saturations (SpO2) were 96.5±1.99 and 97.7±1.98, while 127 infants screened within 24 h of mean preductal and postductal SpO2 were 91.33±2.64 and 94.0±4.44. No CCHD was detected during the study period. Pulse oximetry screening was false positive for CCHD in 9 of 4109 infants (0.02%); of these, six infants were referred to pediatric cardiology and three cases were diagnosed as other significant, non-cardiac pathology. There were two cases with AVSD (atrioventricular septal defect, three cases with ventricular septal defect (VSD), and one case with patent ductus arteriosus (PDA). Saturation values are different between <24-h and >24-h neonates in pulse oximetry screening. The screening in this study identified infants with other important pathologies, this forms an added value as an assessment tool for newborn infants.

Pulse oximetry screening for critical congenital heart diseases at two different hospital settings in Thailand

To evaluate the predictive abilities of pulse oximetry screening (POS) for critical congenital heart disease (CRIT.CHD) at two different hospital settings in Thailand. The study was conducted in healthy newborns at Ramathibodi Hospital (RH), a university hospital and Maharat Nakhon Ratchasima Hospital (MH), a regional hospital. Positive POS was defined as oxygen saturation (SpO2) <95% or difference between pre- and postductal SpO2 >3%. Of 11 407 live births, 10 603 (92.9%) newborns were enrolled with a follow-up rate at 1 month of 78.3%. Incidence of CRIT.CHD (per 1000 live births) at RH and MH were 5.7 and 2.7, respectively. POS could detect three newborns who would have had a missed diagnosis. Sensitivity of POS for CRIT.CHD at RH was 82.3% vs 100% at MH. Overall specificity was 99.9% and false-positive rate was 0.009%. Combination of POS and physical examination (PE) enhanced detection ability to 100% at both hospitals. POS combined with PE improved detection of CRIT.CHD. Routine POS is useful in personnel-limited settings.

Safety and tolerability of subcutaneous treprostinil in newborns with congenital diaphragmatic hernia and life-threatening pulmonary hypertension

BackgroundProlonged pulmonary hypertension (PH) is highly predictive for pulmonary morbidity and death in infants with congenital diaphragmatic hernia (CDH). ObjectivesTo report the effects and tolerability of subcutaneous treprostinil in newborns with severe CDH and late life-threatening PH. MethodsWe recorded clinical and echocardiography data before and after starting subcutaneous treprostinil, on patients with severe CDH and late PH, refractory to inhaled nitric oxide and oral sildenafil. Results14 patients were treated with treprostinil (gestational age: 39.1±2.0weeks; birth weight: 3200±600g). Prior to treatment, the pre- and post-ductal SpO2 difference (Δ SpO2) was 14±10%. Treprostinil was initiated at a median age of 12days [5–157]. After starting treprostinil, ΔSpO2 decreased to 3% at day 7 (p<0.05), and the mean blood flow velocities in the right pulmonary arteries increased by 110% (p<0.05). 2 of the 14 patients died. At the age of follow up (12months to 3years), the 12 surviving infants were all weaned from respiratory support and discharged home. ConclusionThe subcutaneous treprostinil improves pulmonary hemodynamics and outcomes in infants with CDH and life-threatening PH. We suggest that the treatment should be considered in infants with severe CDH and late PH. Type of studyCase series with no comparison group. Level of evidenceLevel IV.

Oxygen saturation ranges for healthy newborns within 24 hours at 1800 m

There are minimal data to define normal oxygen saturation (SpO2) levels for infants within the first 24 hours of life and even fewer data generalisable to the 7% of the...

Pre- and Post-ductal oxygen saturation among apparently healthy low birth weight neonates.

Reference values of oxygen saturation (SpO2) to guide care of low birth weight neonates have been obtained mainly from Caucasians. Data from African newborns are lacking. To determine the pre- and post-ductal SpO2values of low birth weight neonates within the first 72 h of life, compare SpO2values of moderate-late preterm and term low birth weight neonates and determine how mode of delivery affected SpO2in the first 24 h of life. An observational descriptive study was carried out on apparently healthy low birth weight newborns weighing 1500 to ≤2499 g. Pre and post ductal SpO2values were recorded at the following hours of life: 10-24 h, >24-48 h and >48-72 h using a NONIN® pulse oximeter. The ranges of pre- and post-ductal SpO2in the study were similar for both preterm and term neonates in the study (89%-100%). The mean (standard deviation [SD]) pre-ductal SpO2was 95.9% (2.3) and the mean (SD) post-ductal SpO2was 95.9% (2.1). There was a significant increase in pre-ductal SpO2from 10 to 24 h through >48-72 h of life (P = 0.027). The mode of delivery did not affect SpO2values within 10-24 h of life. The present study documented daily single pre- and post-ductal SpO2 values for preterm and term low birth weight neonates weighing 1500 g to <2500 g during the first 72 h of life. The overall range and mean pre- and post-ductal SpO2 were similar for both categories of stable low birth weight neonates in the study. There was no significant difference between SpO2ranges for late preterm compared to term low birth weight neonates. The results obtained could serve as guide in assessing SpO2of low birth weight neonates weighing between 1500 and 2499 g in the first 72 h of life.

Factors Affecting the Target Oxygen Saturation in the First Minutes of Life in Preterm Infants.

The aim of this study was to describe the effect of factors on time to reach a pulse oxygen saturation (SpO2) level of 90% in preterm infants in the delivery room. Preterm (<35 gestational age) infants who did not require supplemental oxygen were included in the study. Continuous recordings were taken by pulse oximetry during the first 15 min of life. Of 151 preterm infants, 79 (52.3%) were female and 126 (83.5%) were delivered by cesarean section. Target saturation level (≥90%) was achieved faster in preductal measurements. Mean times taken to have a preductal and postductal SpO2 level of 90% were significantly lower in preterm babies born by vaginal delivery, with umbilical arterial pH ≥ 7.20 and whose mothers were non-smokers during pregnancy. Differences in achievement of target saturation level were influenced by multiple factors (birth way, probe location, maternal smoking and umbilical blood gas pH) in the delivery room during resuscitation of preterm babies.

Oxygen Saturation Reference Value by Percutaneous Pulse Oximetry in Asymptomatic Newborn Babies in Nigeria: A Cross-Sectional Study

About 1/4 of all neonatal deaths in Nigeria are caused by birth asphyxia. Normal values of oxygen saturation vary according to regional altitudes. They are important for the screening of cyanotic congenital heart diseases and during newborn resuscitation. There is a dearth of such information in Nigeria. We determined reference values for oxygen saturation by pulse oximetry (SpO2) in asymptomatic newborns aged ≤7 days in Enugu at an altitude of 180 m. The study was cross-sectional. Neonates weighing ≥1500 g at birth were enrolled consecutively. Pre-and post-ductal oxygen saturation was measured using a Datex-Ohmeda Tuffsat® pulse oximeter with neonatal probes. Five hundred and fourteen babies comprising of 24 (4.4%) preterm and 490 (95.3%) term neonates were studied. The mean pre-ductal SpO2 of all babies was 96.1% ± 1.4% and higher than mean post-ductal SpO2 of 95.9% ± 1.4% (p = 0.022). The mean pre-ductal SpO2 were 96.1% ± 1.5% and 96.1% ± 1.3%, (p = 1.000) for males and females, respectively. The mean pre-ductal SpO2 values were higher than the mean post-ductal SpO2 for the corresponding post-natal ages.

Pregnancy at high altitude in the Andes leads to increased total vessel density in healthy newborns.

The developing human fetus is able to cope with the physiological reduction in oxygen supply occurring in utero. However, it is not known if microvascularization of the fetus is augmented when pregnancy occurs at high altitude. Fifty-three healthy term newborns in Puno, Peru (3,840 m) were compared with sea-level controls. Pre- and postductal arterial oxygen saturation (SpO2) was determined. Cerebral and calf muscle regional tissue oxygenation was measured using near infrared spectroscopy (NIRS). Skin microcirculation was noninvasively measured using incident dark field imaging. Pre- and postductal SpO2 in Peruvian babies was 88.1 and 88.4%, respectively, which was 10.4 and 9.7% lower than in newborns at sea level (P < 0.001). Cerebral and regional oxygen saturation was significantly lower in the Peruvian newborns (cerebral: 71.0 vs. 74.9%; regional: 68.5 vs. 76.0%, P < 0.001). Transcutaneously measured total vessel density in the Peruvian newborns was 14% higher than that in the newborns born at sea level (29.7 vs. 26.0 mm/mm(2); P ≤ 0.001). This study demonstrates that microvascular vessel density in neonates born to mothers living at high altitude is higher than that in neonates born at sea level.

Use of early pulse oximetry in the detection of cardiac lesions among asymptomatic term newborns

Background and objectivesCardiovascular malformations are the commonest form of congenital defects and could result in significant morbidity. Antenatal and early postnatal detection is still unreliable, especially in developing countries and low-income communities. The aim of the study was to assess the value of early pulse oximetry in the detection of cardiac lesions among asymptomatic term newborns with subnormal oxygen saturation. Patients and methodsA cross-sectional study was conducted at the well-baby nursery of a community hospital, between March and August 2013. A total of 120 asymptomatic, apparently healthy term newborns who had persistent postductal SpO2<95% in the initial and repeat tests within the first 24h after birth were consecutively enrolled. Pulse oximetry testing was performed after the age of 2h and confirmed 2h later. Cases with persistent saturation below 95% underwent echocardiography. ResultsSignificant cardiac lesions were detected in 38 newborns (31.6%); they had significantly lower oxygen saturation compared to those with insignificant lesions (n=41, 34.2%) and normal hearts (n=41, 34.2%). Repeat testing after 2h was more reliable. Using cut-offs lower than 95% missed a significant number of lesions. ConclusionPulse oximetry can be used as a tool in apparently healthy term newborns for the early detection of cardiac lesions that might necessitate specialized follow-up and care. An initial test after the age of 2h followed by a confirmatory test 2h later, with a cut-off value of <95% is proposed. A comprehensive study is necessary to validate the results of this study. This might be of significant importance in low-income communities.