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ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 216-219

Oxygen saturation nomogram by pulse oximetry in the first 24 h of life


Department of Pediatrics, Section Neonatology, Wakra Hospital, Hamad Medical Corporation, Doha, Qatar

Date of Submission25-Mar-2021
Date of Decision15-Jul-2021
Date of Acceptance22-Jul-2021
Date of Web Publication24-Sep-2021

Correspondence Address:
Sarfrazul Abedin
Department of Pediatrics, Section Neonatology, Wakra Hospital, Hamad Medical Corporation, Doha
Qatar
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.jcn_41_21

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  Abstract 


Aims: The aim of this study is to plot a nomogram of oxygen saturation (SpO2) in healthy newborns during the first 24 h of life and study the possible relationship to birth weight, mode of delivery, parity, and gender. Materials and Methods: This was a retrospective study done on a healthy newborn population. The primary purpose of the study was to see preductal saturation during the first 24 h of life and to plot a nomogram of the 5th and 95th percentile for the first 24 h of life. Results: From 5252 babies born in our hospital during 2016, 4139 (78.8%) were included in the study. Mean SpO2 was 98.82%, with a standard deviation of 1.21%. Saturation nomogram of 5th and 95th percentile of preductal saturation during the first 24 h of life was between 96% and 100%. There was no significant difference in gender and mode of delivery. Conclusion: Baseline arterial SpO2 was relatively stable during the first 24 h of life. Moreover, it was similar to the other studies reported earlier.

Keywords: Arterial oxygen saturation, newborn, saturation nomogram


How to cite this article:
Habboub LH, Salameh KM, Abedin S, Vellamgot AP, Valappil RP, Salim ST, Elkabir NA. Oxygen saturation nomogram by pulse oximetry in the first 24 h of life. J Clin Neonatol 2021;10:216-9

How to cite this URL:
Habboub LH, Salameh KM, Abedin S, Vellamgot AP, Valappil RP, Salim ST, Elkabir NA. Oxygen saturation nomogram by pulse oximetry in the first 24 h of life. J Clin Neonatol [serial online] 2021 [cited 2021 Dec 2];10:216-9. Available from: https://www.jcnonweb.com/text.asp?2021/10/4/216/326610




  Introduction/Background Top


In the first few minutes of life, a change from the placenta to lung respiration and circulatory changes occur as the fetus becomes a neonate. This change from the parallel circulation in-utero to the in-series circulation after birth results in a higher overall arterial oxygen saturation (SpO2). The time required for this increase in oxygenation is partially dependent on the presence of residual cardiopulmonary shunts and oxygen availability.[1] Early in the process of cardiopulmonary transition immediately after birth, and before the closure of the ductus arteriosus, the arterial SpO2 in the ascending aorta is higher than that in the descending aorta.[2] Pulse oximetry is an easy and noninvasive method for measuring arterial SpO2 in newborns and is commonly used to evaluate newborns with cardiopulmonary symptoms.[3],[4] Placing twin oximeter probes on the right hand and either foot appears to be an effective method of measuring preductal and postductal saturations.[5] Studies have evaluated this transition period and evaluated preductal and postductal SpO2. A difference in SpO2 between the upper extremities (preductal) and lower extremities (postductal), with lower SpO2, is observed in postductal sites within the 1st h of life.[2],[5] Preductal and postductal SpO2 levels were significantly different during the first 15 min after birth.[4] Postductal pulse SpO2 in healthy newborns infants 2 min after birth was 67%, on average, and it takes 14 min to reach an SpO2 of 95%.[6],[7] The median time to reach an SpO2 of 90% was 5 min in the study by Kamlin et al. and 8 min with Rabi et al.[8],[9]

In a study done by Altuncu et al., the median SpO2 reached 90% at 3.4 min (95% confidence interval [CI]: 3.1–3.7) in the vaginal and 5.8 min (95% CI: 4.3–7.2) in the cesarean deliveries.[10] Saturation of >95% was reached after 12 min (2–55 min) preductally and after 14 min (3–55 min) postductally. In another study by Toth et al., it took 12–14 min for healthy neonates to reach an SpO2 of 95%, and in some cases even 55 min for postductal saturation.[6] Only a few studies evaluated SpO2 in the first 24 h of life. Røsvik et al. found that in healthy newborns, levels of SpO2 measured between 2 and 24 h of life were negatively related to birth weight and related to the mode of delivery, and the average SpO2 for all babies was 98.0% (standard deviation [SD] 1.4).[11] In another study, when SpO2 was measured continuously for 24 h in 90 healthy newborns, the median baseline SpO2 was 98.3% (range 88.7–100).[12] Morgan et al. had constructed a nomogram of SpO2 of newborns born at high altitudes for the first 24 h of life. They found that the 5th–95th percentile range for preductal and postductal SpO2 was 89%–97% for the term and normal birth weight groups and 90%–98% for the preterm and low birth weight groups.[13] As only a few studies evaluated the normal saturation during the first 24 h of life in a good-sized population, we planned a retrospective study to explore this area further. We wanted to plot a nomogram for saturation of the first 24 h of life in a sizeable population.

Objectives

This was a retrospective study done on a healthy newborn population. The study's primary purpose was to examine the preductal saturation during the first 24 h of life and plot a nomogram of the 5th and 95th percentile of preductal saturation during the first 24 h of life. The secondary objective was to compare the saturation with gestational age, weight, and mode of delivery.


  Materials and Methods Top


Babies born at Al Wakra Hospital from January 1, 2016 to December 31, 2016 were included in the study as per our inclusion and exclusion criteria [Flowchart 1]. All babies delivered vaginally or by cesarean, healthy, and did not need neonatal intensive care unit admission were included in the study.



Study procedures

Maternal and baby data were extracted from our electronic documentation system, Cerner software. The saturation and clinical condition of the newborn were recorded in an excel datasheet. A code number was assigned to all babies to hide their identity, and the data were kept in the hospital computer in a password-protected manner. As this was a retrospective study and the participants were de-identified by coding, the need for informed consent was waived off by our institutional review board.

Oximetry

Oximetry was performed using a pulse oximeter GE Dinamap Carescape v100 (General Electric Company, USA) with sensor cable LNOP NeoPt (Masimo Corporation, California, USA). Pulse SpO2 measurement was done by nurses as a part of the routine vital assessment of newborns. The infant's right hand was used for preductal saturation.

The study was conducted in full conformance with principles of the “Declaration of Helsinki,” good clinical practice, and within the laws and regulations of the Ministry of Health, Qatar. The study was started after approval from Medical Research Center-Hamad Medical Corporation (HMC) (HMC, Qatar).

Statistical consideration and data analysis

Descriptive statistics were used to summarize all clinical data of the mother and baby and preductal saturation. The results were reported with mean and SD or frequencies and percentages. Nomogram was plotted with a line chart. Quantitative variables mean between two independent groups were analyzed using the unpaired test. P values presented were two-tailed, and P < 0.05 were considered statistically significant.


  Results Top


A total number of babies born in 2016 were 5252 [Flowchart1]. Among them, 4223 (80.4%) babies were eligible for data collection as per our inclusion and exclusion criteria. Data were collected for 4139 (78.8%) babies; as for 84 (1.6%) babies, saturation was not recorded in the first 24 h of life.

Baseline data are represented in [Table 1]. The mean arterial SpO2 for our babies was 98.82%, and the SD was 1.21%.
Table 1: Baseline data

Click here to view


Nomogram for the first 24 h saturation was plotted in [Chart 1] (first 24 h arterial saturation nomogram plot). As per our calculation, 5th centile for the first 24 h saturation was mostly at 97%.



The comparison of different subgroups is represented in [Table 2]. The mean saturation was similar between males (98.85%) and females (98.8%) and did not vary with the mode of delivery, vaginal delivered 98.85% versus cesarean 98.77%. Although babies of primipara mothers had slightly higher mean saturation (P = 0.0069) than babies of multiparous mothers (babies of primipara mother 98.9% vs. babies of multiparous mother 98.79%), the difference was clinically insignificant as even <1%. A similar clinically insignificant difference in saturation was observed between the two weight categories (P = 0.038), for 2–3 kg weight category 98.89% versus 3–4 kg weight category 98.8%.
Table 2: Arterial oxygen saturation comparisons in different groups

Click here to view



  Discussion Top


We have done arterial SpO2 measurement of neonates at sea level with a good sample size (4139 babies). As per our study, the 5th centile of saturation in the first and 15th h of life was 96%, and the rest of the time, it was near 97%. The 95th centile was 100% during the first to 24 h of life.

The mean arterial SpO2 for our babies was 98.82%, and the SD was 1.21%. Similar findings were reported in other studies. Røsvik et al. reported average saturation of 98.0% (SD 1.4) in healthy newborns between 2 and 24 h of life.[11] In another study, when SpO2 was measured continuously for 24 h in 90 healthy newborns, the median baseline SpO2 was 98.3% (range 88.7–100).[12]

We did not find a significant difference in saturation during the first 24 h of life in terms of sex and mode of delivery. In terms of birth weight (for 2–3 kg category 98.89% vs. for 3–4 kg category 98.8%) and parities (for primipara mother babies 98.9% vs. multipara mother babies 98.79%), these were statistically significant but clinically not significant as the difference is <1%. Røsvik et al. found that in healthy newborns, levels of SpO2 measured between 2 and 24 h of life were negatively related to birth weight and related to the mode of delivery.[11]

As a retrospective study, some key statistics cannot be measured, and significant bias cannot be ruled out for information dependent on electronic documentation systems.


  Conclusion Top


Baseline arterial SpO2 was relatively stable during the first 24h of life. Moreover, it was similar to the other studies reported earlier. There was no statistically significant difference in terms of sex or mode of delivery. However, a clinically insignificant statistical significance was observed with maternal parity and also with birth weight.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
East CE, Colditz PB, Begg LM, Brennecke SP. Update on intrapartum fetal pulse oximetry. Aust N Z J Obstet Gynaecol 2002;42:119-24.  Back to cited text no. 1
    
2.
Urlesberger B, Brandner A, Pocivalnik M, Koestenberger M, Morris N, Pichler G. A left-to-right shunt via the ductus arteriosus is associated with increased regional cerebral oxygen saturation during neonatal transition. Neonatology 2013;103:259-63.  Back to cited text no. 2
    
3.
Dawson JA, Davis PG, O'Donnell CP, Kamlin CO, Morley CJ. Pulse oximetry for monitoring infants in the delivery room: A review. Arch Dis Child Fetal Neonatal Ed 2007;92:F4-7.  Back to cited text no. 3
    
4.
Mariani G, Dik PB, Ezquerra A, Aguirre A, Esteban ML, Perez C, et al. Pre-ductal and postductal O2 saturation in healthy term neonates after birth. J Pediatr 2007;150:418-21.  Back to cited text no. 4
    
5.
Rüegger C, Bucher HU, Mieth RA. Pulse oximetry in the newborn: Is the left hand pre- or post-ductal? BMC Pediatr 2010;10:35.  Back to cited text no. 5
    
6.
Toth B, Becker A, Seelbach-Göbel B. Oxygen saturation in healthy newborn infants immediately after birth measured by pulse oximetry. Arch Gynecol Obstet 2002;266:105-7.  Back to cited text no. 6
    
7.
Harris AP, Sendak MJ, Donham RT. Changes in arterial oxygen saturation immediately after birth in the human neonate. J Pediatr 1986;109:117-9.  Back to cited text no. 7
    
8.
Kamlin CO, O'Donnell CP, Davis PG, Morley CJ. Oxygen saturation in healthy infants immediately after birth. J Pediatr 2006;148:585-9.  Back to cited text no. 8
    
9.
Rabi Y, Yee, W, Chen SY. Oxygen saturation trends immediately after birth. J Pediatr 2006;148:590-4.  Back to cited text no. 9
    
10.
Altuncu E, Ozek E, Bilgen H, Topuzoglu A, Kavuncuoglu S. Percentiles of oxygen saturations in healthy term newborns in the first minutes of life. Eur J Pediatr 2008;167:687-8.  Back to cited text no. 10
    
11.
Røsvik A, Øymar K, Kvaløy JT, Berget M. Oxygen saturation in healthy newborns; influence of birth weight and mode of delivery. J Perinat Med 2009;37:403-6.  Back to cited text no. 11
    
12.
O'Brien LM, Stebbens VA, Poets CF, Heycock EG, Southall DP. Oxygen saturation during the first 24 hours of life. Arch Dis Child Fetal Neonatal Ed 2000;83:F35-8.  Back to cited text no. 12
    
13.
Morgan MC, Maina B, Waiyego M, Mutinda C, Aluvaala J, Maina M, et al. Oxygen saturation ranges for healthy newborns within 24 hours at 1800 m. Arch Dis Child Fetal Neonatal Ed 2017;102:F266-8.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2]



 

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