Paediatrica Indonesiana Detection of hypoxemia and hyperoxemia

Paediatrica Indonesiana
November
VOLUME 48
NUMBER 6
Original Article
Detection of hypoxemia and hyperoxemia by pulse
oximetry in neonates and children
Sri Murni A. Ritonga, Ekawati Lutfia Haksari, Purnomo Suryantoro
Abstract
Objective To assess the validity of pulse oximetry for detecting
hypoxemia and hyperoxemia in neonates and children.
Methods This was a diagnostic test study conducted in Neonatal
Intensive Care Unit (NICU). The subjects of the study were
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Hypoxemia and hyperoxemia were obtained by using NellcorR
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as a gold standard.
Results 7KHUHZHUHQHRQDWHV DQGFKLOGUHQ enrolled in
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Conclusion 3XOVHR[LPHWU\KDVDIDLUO\JRRGYDOLGLW\LQGHWHFWLQJ
hypoxemia in neonates and children and in detecting hyperoxemia
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hyperoxemia in neonates.[Paediatr Indones. 2008;48:346-9].
H
ypoxemia is one of the causes that can
increase the risk of mortality while
hyperoxemia can be toxic leading to a
condition that damages tissues. Blood gas
analysis (BGA) is the gold standard of examination
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due to needle pricks.
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oxygen saturation and is frequently used to replace
BGA examination. It is inaccurate to be used in
low saturation because it may give high biases; on
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measurement by pulse oximetry that exceeds from the
actual result.1 The results of the correlation between
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while pulse oximetry gives a high correlation result
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illustrated conditions become the background of
this study to investigate the diagnostic value of pulse
oximetry in assessing oxygen saturation.
Keywords: blood gas analysis, pulse oximetry, oxygen
saturation, hypoxemia, hyperoxemia, diagnostic test
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346Paediatr Indones, Vol. 48, No. 6, November 2008
Sri Murni A. Ritonga et al: Detection of hypoxemia and hyperoxemia by pulse oximetry
Methods
:HFRQGXFWHGDGLDJQRVWLFWHVWVWXG\WRLQYHVWLJDWH
the diagnostic value of pulse oximetry with
NellcorR in detecting hypoxemia and hyperoxemia
in neonates and children. Capillary BGA was the
gold standard for neonates and arterial BGA was
for children.
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days admitted to Neonatal Intensive Care Unit
(NICU) and children of one month to 14 years old
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Dr. Sardjito Hospital in need of BGA examination from
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FRQJHQLWDOKHDUWGLVRUGHUZRXQGRUSKOHELWLVRQWKH
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who declined to join the study.
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attendants (residents) were trained on how to use
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forms. They did not receive any explanation about the
definition of hypoxemia or hyperoxemia intended by
the investigators. The results were read and noted
by other attendants. The neonates and children
who needed BGA examination also underwent the
assessment of oxygen saturation with pulse oximetry
at the same time. Hypoxemia in neonate was defined
DV3D2FDSLOODU\ZDVPP+J4 and in children
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+\SHUR[HPLDZDVGHILQHGDV3D2 from capillary BGA
RI!PP+J3 to whereas in children when arterial
3D2ZDV!PP+J By using Receiver Operator
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hyperoxemia detection to get the best diagnostic was
determined.
Results
During the period of April 1st ² -XQH th VSHFLPHQV RI QHRQDWHV FDSLOODU\ %*$ DQG specimens of children’s arterial BGA were collected.
Table 1 shows the characteristics of the neonate
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RI WHUP JHVWDWLRQDO DJH ZHHNV ZDV Table 1. Characteristics of the neonates
Characteristics
Sex (n/%)
Male
Female
Age, days, mean (range)
Gestational age (n/%)
< 28 weeks
28 - < 37 weeks
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>42 weeks
Pulse rate, per minute, mean (range)
Respiratory rate, per min., mean (range)
Temperature, °C, mean (range)
Hemoglobin, g/dl, mean (range)
Diagnosis, n (%)
Asphyxia
Meconium aspiration syndrome
Pneumonia
HMD (hyaline membrane disease)
Apnea of prematurity
ARDS (acute respiratory distress syndrome)
Hydrocephalus
Aspiration
152 (63.3)
88 (36.7)
7 (0-62)
17 (7.1)
69 (28.8)
140 (58.3)
14 (5.8)
146 (100-213)
53 (30-98)
37 (36.5-40)
15.2 (10-21.6)
106 (44)
36 (15)
37 (15.4)
29 (12.1)
15 (6.2)
13 (5.4)
2 (0.8)
2 (0.8)
The characteristics of children group are shown
in Table 22IVXEMHFWVZHUHPDOH
with mean age of 31.6 months. The most prevalent
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specificity as the lowest cut-off points in determining
Table 2. Basic characteristics of the children
Characteristics
Sex, n (%)
Male
176 (65.7)
Female
92 (33.3)
Age, mo, mean (range)
31.6 (1.5-156)
Heart rate per minute, mean (range)
153 (92-205)
Resp. rate per minute, mean (range)
42 (20-80)
Temperature, °C, mean (range)
37.6 (36.5-40)
Systolic blood pressure, mmHg, mean (range)
113 (80-160)
Diastolic blood pressure, mmHg, mean (range)
66 (40-114)
Mean arterial pressure, mmHg, mean (range)
82 (52-126)
Hemoglobin, g/dl, mean (range)
11 (9-20)
Diagnosis, n (%)
Pneumonia
58 (24.2)
Bronchial asthma
43 (16)
ARDS (acute resp. distress syndrome)
33 (12.3)
Encephalitis
40 (16.7)
CLD (chronic lung disease)
26 (9.7)
Meningoencephalitis
19 (7.1)
Wheezy infant
15 (5.6)
Intracranial bleeding
14 (5.8)
Bronchiolitis
12 (4.5)
Renal failure
6 (2.3)
Pleural effusion
2 (0.7)
Paediatr Indones, Vol. 48, No. 6, November 2008347
Sri Murni A. Ritonga et al: Detection of hypoxemia and hyperoxemia by pulse oximetry
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highest cut-off points in determining hyperoxemia in
neonates. The sensitivity and specificity in neonates
are shown in Table 3.
Table 3. Prediction of hypoxemia and hyperoxemia in neonates
Lowest cut-off
95%
95%
Sensitivity
5RGEKſEKV[
point SpO2
%QPſFGPEG
%QPſFGPEG
(%)
(%)
(%)
Interval (%)
Interval (%)
90
70
58 to 82
81
75 to 87
91
81
70 to 91
79
73 to 85
92
84
70 to 91
77
73 to 85
Highest cut-off
point SpO2
(%)
94
64
56 to 72
82
75 to 90
95
78
71 to 95
66
56 to 75
96
82
76 to 88
63
53 to 72
97
88
82 to 93
59
50 to 69
Capillary BGA was used as reference
,Q FKLOGUHQ VDWXUDWLRQ RI DQG presented fairly good sensitivity and specificity as
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DQG VDWXUDWLRQ DQG H[KLELWHG EHWWHU
sensitivity and specificity as the highest cut-off point
in determining hyperoxemia. These can be seen in
Table 4.
Table 4. Prediction of hypoxemia and hyperoxemia in children
95%
95%
Lowest cut-off Sensitivity
5RGEKſEKV[
%QPſFGPEG
%QPſFGPEG
point SpO2 (%)
(%)
(%)
Interval (%)
Interval (%)
89
69
58 to 80
96
93 to 99
90
80
58 to 80
95
93 to 99
91
77
67 to 87
95
91 to 98
Highest cut-off
point SpO2 (%)
96
73
65 to 81
88
82 to 93
97
81
74 to 88
79
72 to 86
98
89
84 to 95
67
59 to 74
Arterial BGA as gold standard
the oxyhemoglobine dissociation curve (OHDC) in
each infant and children after a blood gas analysis
result we should take into account some of the factors
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frequently in an individual infant and child because
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the study would have received red cell transfusion.
Therefore this may have affected the position of
the OHDC by altering the amount of circulating
hemoglobin F. Although this theoretically affects
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results.
The magnitude of sensitivity and specificity to
detect hypoxemia and hyperoxemia tended to be lower
in neonates in our study. This might be because the
gold standard that was used was not from the analysis
of arterial blood gas that described the actual level of
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gas while it was known that the correlation between
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validity in detecting hypoxemia in neonates and
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hyperoxemia in neonates.
Reference
1.
Discussion
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oximetry for detecting hypoxemia and hyperoxemia.
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arterial oxyhaemoglobin saturation (SaO) in sick
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348Paediatr Indones, Vol. 48, No. 6, November 2008
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study of blood gas and acid base parameters of capillary with
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