Pulse oximetry reliability for detection of hypoxemia under motion in extremely premature infants.

Abstract

Episodes of intermittent hypoxemia (IH) in extremely premature infants are detected by pulse oximetry (SpO₂) but motion artifact can cause falsely low readings. To evaluate the reliability of SpO₂ during IH episodes associated with motion in premature infants of ≤28 weeks GA monitored with 2 pulse oximeters. IH episodes (defined as SpO₂ < 90%, >10 s and SpO₂ < 80%, >10 s) were classified by an analytic tool based on distortion caused by motion in the pulse plethysmograph (Pleth) as: A (true hypoxemia), both SpO₂ decreased (only one Pleth showed motion); B (false hypoxemia), one SpO₂ decreased (Pleth showed motion) and the other didn't (Pleth didn't show motion); C (suspected hypoxemia), both SpO₂ decreased (both Pleth showed motion); D (true hypoxemia-motion free), both SpO₂ decreased (neither Pleth showed motion). In 24-72 h data from 20 infants of 25.4 ± 1.5 weeks GA, 14.1 ± 5.7 episodes with SpO₂ < 90% and 7.9 ± 5.5 episodes with SpO₂ < 80% per infant were identified. 29 ± 15% of episodes with SpO₂ < 90% were type A, 1 ± 2% B, 43 ± 21% C and 27 ± 23% D, while 26 ± 22% of episodes with SpO₂ < 80% were type A, 0.3 ± 1.2% B, 45 ± 29% C, and 19 ± 25% D [p < 0.001 type B vs. rest (GLM-repeated measures)]. In extremely premature infants SpO₂ with motion artifact is more likely to indicate true- than false hypoxemia. Uncertainty on the effect of motion on SpO₂ accuracy during hypoxemia episodes in premature infants can influence the caregiver's trust on SpO₂ and influence their response. This study evaluated data from two pulse oximeters used simultaneously in different extremities to determine the reliability of SpO₂ during motion artifact in premature infants. Data from this study showed that in extremely premature infants SpO₂ is more likely to indicate true- than false hypoxemia during episodes of hypoxemia associated with motion artifact.