Pulse Oximetry In Children Research Articles

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.

Peculiarities of the state of peripheral oxygenation of tissues in different kinds of combined anesthesia in children with congenital surgical pathology

In the presented work, we have assessed the features of peripheral oxygenation in children with congenital malformations of the surgical profile under various types of combined anesthesia.
 The aim of the study. To assess the state of peripheral oxygenation in newborns and infants with congenital malformations with various types of anesthetic support.
 Materials and research methods. A retrospective study included 150 newborns and infants with congenital malformations of the surgical profile, depending on the anesthesia (inhalation + regional anesthesia; inhalation + intravenous anesthesia and total intravenous). The parameters of pulse oximetry were analyzed: peripheral oxygenation, heart rate. Additionally, the concentration of oxygen in the respiratory mixture of children was taken into account.
 Research results. Peripheral saturation did not critically decrease at all stages of observation, with the exception of a decrease in the indicator in children of group I compared with group III at the stage of induction into anesthesia (97.79±2.45 versus 98.79±1.63, at p˂0.05, respectively) and at the most painful moment of the operation (96.29±3.47 versus 98.10±2.47, with p˂0.05). At the painful moment of the operation, it was in children of group I that a drop in heart rate was noted compared to group III (127.98±13.77 and 136.10±15.37, respectively, with p˂0.05) and group II (134.02±18.43, at p>0.05) against the background of a decrease in SpO2. Newborns and group I infants required higher oxygen concentrations in the breathing mixture. A significant difference in the indicator is noted between groups I and III at the traumatic stage – 0.47±0.29 and 0.33±0.2, with p˂0.05, respectively, and immediately after the operation – 0.34±0,19 and 0.26±0.13, with p˂0.05, respectively.
 Conclusions. The expediency and effectiveness of pulse oximetry for children with congenital malformations at all stages of anesthetic support during surgical treatment was confirmed. The risk group for the formation of oxygen deficiency in organs and tissues, the occurrence of pain during the operation were newborns and infants, for whom combined anesthesia was chosen in the form of an inhalation method and regional anesthesia. In the case of the appointment of this type of anesthetic support, it is necessary to more closely monitor the indicators and promptly correct the deterioration of the child's condition

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.

Pulse oximetry for children with pneumonia treated as outpatients in rural Malawi.

ObjectiveTo investigate implementation of outpatient pulse oximetry among children with pneumonia, in Malawi.MethodsIn 2011, 72 health-care providers at 18 rural health centres and 38 community health workers received training in the use of pulse oximetry to measure haemoglobin oxygen saturations. Data collected, between 1 January 2012 and 30 June 2014 by the trained individuals, on children aged 2–59 months with clinically diagnosed pneumonia were analysed.FindingsOf the 14 092 children included in the analysis, 13 266 (94.1%) were successfully checked by oximetry. Among the children with chest indrawing and/or danger signs, those with a measured oxygen saturation below 90% were more than twice as likely to have been referred as those with higher saturations (84.3% [385/457] vs 41.5% [871/2099]; P < 0.001). The availability of oximetry appeared to have increased the referral rate for severely hypoxaemic children without chest indrawing or danger signs from 0% to 27.2% (P < 0.001). In the absence of oximetry, if the relevant World Health Organization (WHO) guidelines published in 2014 had been applied, 390/568 (68.7%) severely hypoxaemic children at study health centres and 52/84 (61.9%) severely hypoxaemic children seen by community health workers would have been considered ineligible for referral.ConclusionImplementation of pulse oximetry by our trainees substantially increased the referrals of Malawian children with severe hypoxaemic pneumonia. When data from oximetry were excluded, retrospective application of the guidelines published by WHO in 2014 failed to identify a considerable proportion of severely hypoxaemic children eligible only via oximetry.

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.

Accuracy of Pulse Oximetry in Children

For children with cyanotic congenital heart disease or acute hypoxemic respiratory failure, providers frequently make decisions based on pulse oximetry, in the absence of an arterial blood gas. The study objective was to measure the accuracy of pulse oximetry in the saturations from pulse oximetry (SpO2) range of 65% to 97%. This institutional review board-approved prospective, multicenter observational study in 5 PICUs included 225 mechanically ventilated children with an arterial catheter. With each arterial blood gas sample, SpO2 from pulse oximetry and arterial oxygen saturations from CO-oximetry (SaO2) were simultaneously obtained if the SpO2 was ≤ 97%. The lowest SpO2 obtained in the study was 65%. In the range of SpO2 65% to 97%, 1980 simultaneous values for SpO2 and SaO2 were obtained. The bias (SpO2 - SaO2) varied through the range of SpO2 values. The bias was greatest in the SpO2 range 81% to 85% (336 samples, median 6%, mean 6.6%, accuracy root mean squared 9.1%). SpO2 measurements were close to SaO2 in the SpO2 range 91% to 97% (901 samples, median 1%, mean 1.5%, accuracy root mean squared 4.2%). Previous studies on pulse oximeter accuracy in children present a single number for bias. This study identified that the accuracy of pulse oximetry varies significantly as a function of the SpO2 range. Saturations measured by pulse oximetry on average overestimate SaO2 from CO-oximetry in the SpO2 range of 76% to 90%. Better pulse oximetry algorithms are needed for accurate assessment of children with saturations in the hypoxemic range.

Accuracy of Pulse Oximetry in Children

Accuracy of Pulse Oximetry in Children

Pulse oximetry in children

Pulse oximetry is routinely used in hospitals in high-income settings, but its theoretical basis is often poorly understood.1 This paper summarises the physiological background, technological basis and limitations of pulse...

Nocturnal haemoglobin oxygen saturation variability is associated with vitamin C deficiency in Tanzanian children with sickle cell anaemia

AimTo compare pulse oximetry in children with sickle cell anaemia (SCA) and controls and test the hypothesis that vitamin C deficiency (VCD; <11.4 μmol/L) is associated with nocturnal haemoglobin oxygen desaturation in SCA.MethodsWe undertook nocturnal and daytime pulse oximetry in 23 children with SCA (median age 8 years) with known steady-state plasma vitamin C concentrations and 18 siblings (median 7 years).ResultsMedian nocturnal delta 12 s index (delta12 s), a measure of haemoglobin oxygen saturation (SpO2) variability, was 0.38 (interquartile range 0.28–0.51) in SCA and 0.35 (0.23–0.48) in controls, with 9/23 and 6/18, respectively, having a delta12 s >0.4, compatible with obstructive sleep apnoea (OSA). Eleven of twenty-three with SCA had VCD; logged vitamin C concentrations showed a 66% decrease per 0.1 unit increase in delta12 s ([95% CI −86%, −15%]; p = 0.023) and delta12 s >0.4 was associated with VCD (odds ratio 8.75 [1.24–61.7], p = 0.029). Daytime and mean nocturnal SpO2 were lower in SCA but there was no association with vitamin C.ConclusionObstructive sleep apnoea (OSA), detected from nocturnal haemoglobin oxygen saturation variability, is common in Tanzanian children and associated with vitamin C Deficiency in SCA. The direction of causality could be determined by comparing OSA treatment with vitamin C supplementation.

Accuracy of Pulse Oximetry in Children with Congenital Heart Disease.

Background: Detection of arterial oxygen saturation in pediatric patients with congenital heart disease (CHD) can be helpful for their management. Methods: We compared oxygen saturation and heart rate detected by pulse oximeter with the data of cardiac catheterization in order to determine the reliability and pitfalls of pulse oximetry (PO) in pediatric patients with CHD. 110 patients with different cyanotic and acyanotic CHD who were referred for right and left sided cardiac catheterization were enrolled in this study PO from left index finger and simultaneous oxygen saturations and pressures from cardiac catheterization were recorded. Results: There was a statistically significant correlation (r= 0.68, p<0.0001) between measured oxygen saturation by PO and aortic oxygen saturation and between heart rate in elctrocardiography (ECG) and heart rate recorded by PO (r=0.94, p<0.0001) respectively. This study also showed that presence of cyanosis (p=0.01), digital clubbing (p=0.001), low oxygen saturation in supra-vena cava and right atrium (p=0.002, P= 0.01) can decrease accuracy of PO for detection of arterial oxygen saturation. High mean right atrial pressure can affect the accuracy of PO for detection of heart rate (P=0.034). PO had maximum sensitivity and specificity for detecting saturation of 88% and heart rate of 99 beat/min. Conclusion: Pulse oximetry, within the above limits of accuracy, is a useful tool for estimation of arterial oxygen saturation and heart rate in children with CHD.

The effect of adenotonsillectomy on oxygen saturation in children with sleep breathing disorders

To evaluate the effect of adenotonsillectomy on the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders (SBD). A non-controlled clinical trial was performed. Thirty-one children with suspected SBD and a clinical indication for adenotonsillectomy were recruited. All of them underwent overnight oxygen saturation monitoring before and after surgery. Twenty-seven patients completed the study. The mean age was 5.2+/-1.8 years. Eighteen (66.7%) were male. The most prevalent symptoms were: snoring (100%), respiratory pauses (96.8%), nocturnal mouth breathing (96.8%), restless sleep (80%) and drooling (74.1%). Twenty-three children (85.2%) presented grade 3 or 4 tonsillar hyperplasia. There was a significant improvement in the postoperative oxygen desaturation index (ODI) (0.65; 0.5-1.3) compared with the preoperative index (1.63; 1.1-2.4) (p<0.001). Adenotonsillectomy improved the oxygen saturation measures by nocturnal pulse oximetry in children with sleep breathing disorders.

O efeito da adenotonsilectomia na saturação de oxigênio em crianças com distúrbios respiratórios do sono

To evaluate the effect of adenotonsillectomy on oxygen saturation measured through nocturnal pulse oximetry in children with sleep disordered breathing. A pre- and post-intervention study was carried out using nocturnal pulse oximetry. The study involved 31 children who were suspected of having sleep disordered breathing and had been referred for adenotonsillectomy. A total of 27 children completed the study. The mean age was 5.2 +/- 1.8 years, and 18 (66.7%) of them were male. Upon physical examination, 23 (85.2%) of the children presented class III or class IV hyperplasia of the palatine tonsils. There was significant improvement in the post-operative period over the pre-operative period in terms of the oxygen desaturation rate (OR = 0.65; 95% CI: 0.5-1.3 vs. OR = 1.63; 95% CI: 1.1-2.4; p < 0.001). Adenotonsillectomy significantly improved oxygen saturation, as measured through nocturnal pulse oximetry, in children with sleep disordered breathing.

Effect of peripheral perfusion on accuracy of pulse oximetry in children

Study Objective: To examine the effect of perfusion on accuracy of two pulse oximeters in children and to determine thresholds of perfusion below which these pulse oximeters become inaccurate or cease to function. Design: Prospective, observational clinical study. Setting: Operating room of a large university hospital. Patients: 19 children 10 years of age or less, who were scheduled for general anesthesia with placement of an intraarterial catheter. Interventions: A radial artery catheter, laser Doppler probe, skin temperature sensor, and band probes of two oximeters, Ohmeda 3700 (Boulder, CO) and Nellcor N200 (Hayward, CA), were attached to the same hand. Baseline pulse oximeter and Doppler readings were obtained with simultaneous hemoximetry (AVL Model 912 CO-Oxylite, Roswell, GA), skin and esophageal temperatures, total hemoglobin, and transduced arterial pressure. Readings of all parameters (n = 94) were obtained during periods of low perfusion or by occluding the upper arm to 70% to 100% of systolic pressure. Measurements and Main Results: Bias (SpO 2 − SaO 2) of each oximeter is compared to each perfusion variable (age, weight, core and skin temperature, hemoglobin concentration, pulse pressure, and percent flow by laser Doppler) to determine effect on accuracy. Data were analyzed using backward multivariate linear regression, Pearson correlation coefficients, and independent paired t-test. p < 0.05 was considered significant. Less than 2% bias is seen with either oximeter (Nellcor 1.55 ± 2.33, Ohmeda 0.78 ± 2.25). Independent predictors of bias for each machine include weight (r = −0.376; p < 0.001) and pulse pressure (r = 0.250; p = 0.021) for the Nellcor, and weight (r = −0.390; p < 0.001), percent flow by Doppler (r = 0.220; p = 0.035), and core temperature (r = 0.307; p = 0.003) for the Ohmeda. However, using predetermined thresholds for each variable, only skin temperature below 30°C is identified as a significant predictor of oximeter inaccuracy. Conclusions: At the parameters explored in this study, the selected seven perfusion variables (age, weight, core and skin temperature, hemoglobin concentration, pulse pressure, and percent flow by laser Doppler) have little effect on accuracy of pulse oximetry in children.

Effect of probe design on accuracy and reliability of pulse oximetry in pediatric patients

Study Objective: To determine if the traditional band-wrap disposable pulse oximeter probe is more accurate or reliable for oxygen monitoring in children than the reusable clip-type probe. Design: Prospective, observational clinical study. Setting: Operating room of a large university hospital. Patients: 18 children 11 years of age or younger, who were scheduled for general anesthesia with placement of an intraarterial catheter. Interventions: Pulse oximetry values were obtained using both band and clip probes of three pulse oximeters (Nellcor, Hayward CA; Novametrix, Wallingford, CT; Ohmeda, Boulder, CO) and compared with simultaneous hemoximetry values. Dropout rate (percent of down time) also was recorded for each probe-machine combination. Measurements and Main Results: Data were analyzed using bias and precision and t-test. p < 0.05 is considered significant. Bias (mean SpO 2 − SaO 2) is less than 2% for all probe-machine combinations. The range of error observed between SpO 2 and SaO 2for all data points was greatest using the Nellcor band (27.8%) and least using the Ohmeda band (11.4%). In cyanotic children, the greatest bias and precision were observed with Nellcor band (N = 11, −5.12 ± 9.74) and the best agreement with Novametrix band (N = 17, 0.08 ± 4.21). The difference in bias for any test units above or below the median weight of 13.75 kg did not vary by more than 1%. Dropout rate was minimal for all units in nonbypass situations. After cardiopulmonary bypass, no data dropout was observed with Ohmeda band; observed down time with the other units varied between 34% and 55%. Conclusions: The type of probe selected has little effect on accuracy of pulse oximetry in children. After cardiopulmonary bypass, using the Ohmeda band combination may improve the likelihood of obtaining consistent readings and decreasing down time.

A modified sensor for pulse oximetry in children

A modified sensor for pulse oximetry in children