Accuracy and reliability of pulse oximetry in premature neonates with respiratory distress.

Continuous noninvasive monitoring of oxygenation in premature neonates with respiratory distress is essential to avoid the potential complications of hypoxemia and hyperoxia. The accuracy and reliability of pulse oximetry (using an Ohmeda Biox) was evaluated in 15 premature neonates. Pulse oximetry oxygen saturation readings closely approximated arterial oxygen saturation values analyzed by an IL 282 C O-Oximeter (Instrumentation Laboratory, Lexington, MA). Forty-five pooled data points were obtained, and analysis was performed by linear regression y = +1.19x-18.16, r = +0.87. There was no correlation between car-boxyhemoglobin levels (range 3.2% to 9.9%) and the difference between pulse oximetry and arterial oxygen saturations. Ninety-five percent of the data points collected fell within the 85% to 95% saturation range. The correlation between pulse oximetry and arterial saturation found in the present study may not be generalizable to extremes in oxygen saturation in the premature neonate. This study demonstrates the accuracy and reliability of pulse oximetry within the 85% to 95% saturation range in premature infants with respiratory distress over a wide range of carboxyhemoglobin concentrations. 224 Medical management of the premature neonate with respiratory disease has been improved by technology that allows continuous monitoring of arterial oxygenation. Administration of oxygen as a method of combating respiratory problems of the newborn has been documented in the literature as early as the 19th century. The unreliability of intermittent blood gas sampling, and the many complications from more invasive techniques of blood gas determinations, have resulted in the current emphasis on continuous noninvasive methods of blood gas monitoring. 1-4 Critically ill neonates will develop periods of life-threatening desaturation. The potential se-quelae of hypoxemia in the neonate include increased pulmonary vascular resistance, persistent pulmonary hypertension, neurological impairment, intellectual deficits, respiratory compromise and, finally, circulatory collapse. However, the administration of oxygen to prematurely born neonates is not without hazard. The use of supplemental oxygen with these infants has been associated with an increased incidence of retinopathy of prematurity and bronchopulmonary dysplagia. Since the retinal vasculature does not mature until after birth at full term, the premature neonate is at risk for developing retino-pathy of prematurity before the conceptual age of 44 weeks. The literature has documented cases of retinopathy of prematurity in preterm infants where the only supplemental oxygen received was during the course of a general anesthetic. Oximetry is a continuous noninvasive method of evaluating the oxygenation of arterial blood by measuring spectrophotometrically the percentage Journal of …