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

Background: Episodes of intermittent hypoxemia (IH) in extremely premature infants are detected by pulse oximetry (SpO) but motion artifact can cause falsely low readings.

Objectives: To evaluate the reliability of SpO during IH episodes associated with motion in premature infants of ≤28 weeks GA monitored with 2 pulse oximeters.

Methods: IH episodes (defined as SpO < 90%, >10 s and SpO < 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 SpO decreased (only one Pleth showed motion); B (false hypoxemia), one SpO decreased (Pleth showed motion) and the other didn't (Pleth didn't show motion); C (suspected hypoxemia), both SpO decreased (both Pleth showed motion); D (true hypoxemia-motion free), both SpO decreased (neither Pleth showed motion).

Results: In 24-72 h data from 20 infants of 25.4 ± 1.5 weeks GA, 14.1 ± 5.7 episodes with SpO < 90% and 7.9 ± 5.5 episodes with SpO < 80% per infant were identified. 29 ± 15% of episodes with SpO < 90% were type A, 1 ± 2% B, 43 ± 21% C and 27 ± 23% D, while 26 ± 22% of episodes with SpO < 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)].

Conclusion: In extremely premature infants SpO with motion artifact is more likely to indicate true- than false hypoxemia.

Impact: Uncertainty on the effect of motion on SpO accuracy during hypoxemia episodes in premature infants can influence the caregiver's trust on SpO and influence their response. This study evaluated data from two pulse oximeters used simultaneously in different extremities to determine the reliability of SpO during motion artifact in premature infants. Data from this study showed that in extremely premature infants SpO is more likely to indicate true- than false hypoxemia during episodes of hypoxemia associated with motion artifact.