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A Comparison of Pulse Oximetry and Near Infrared Spectroscopy (NIRS) in the Detection of Hypoxaemia Occurring With Pauses in Nasal Airflow in Neonates

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Abstract

Objective.The aim of this study was to compare the ability of NIRSand pulse oximetry to detect changes in cerebral oxygenation occurring inresponse to a pause in nasal airflow (PNA). Methods.Twenty-onerecordings of cerebral oxygenation index by NIRS together with oxyhemoglobinsaturation by pulse oximetry were measured on 17 preterm infants with ahistory of apnoea. Photoplethysmography was used to confirm the accuracy ofthe pulse oximetry data. PNA events were defined as pauses of greater than 4seconds in a thermistor trace measuring nasal air flow. Results.Baseline variability in oxygenation index (Hbdiff) was found to be from−0.12 to +0.13 µmol 100 g brain−1. A fall in Hbdiff orSpO2 was defined as a decrease of greater magnitude than 2 standarddeviations from the baseline, i.e., −0.12 µmol 100 gbrain−1 and 3% respectively. In 68% of 468 PNA events a fall inoxyhemoglobin saturation (SpO2) was detected and in 56% a fall inHbdiff was detected. In 20% of events there was no fall in cerebraloxygenation despite a fall in SpO2. In 8% of PNA episodes werecorded a fall in cerebral oxygenation but no fall in SpO2. Whena fall in cerebral oxygenation was recorded, the fall was greater when theevent was also associated with a fall in SpO2 (median(interquartile range (IQR)) 0.32 (0.21–0.69) vs. 0.25 (0.16–0.43)µmol 100g brain−1, p < 0.05). When all the PNAepisodes were reviewed no close correlation was shown between the magnitudeof change in cerebral oxygenation and the change in SpO2 for smallchanges in both indices. However, large falls (>1.5 µmol 100 gbrain−1) in cerebral oxygenation were closely associated with largechanges in SpO2. Conclusions.We conclude that bothtechniques are sensitive to changes in oxygenation during PNA. Small changesin cerebral Hbdiff and arterial SpO2 do not always correlate forphysiological reasons. A change in Hbdiff of >0.3 µmol 100 gbrain−1 is likely to be physiologically significant and isassociated with a change in SpO2 of 12%.

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Authors and Affiliations

  1. Department of Paediatrics, Nottingham City Hospital, Nottingham, U.K

    S. L. Watkin

  2. Academic Department of Paediatrics and Biomedical Engineering, North Staffordshire NHS Trust/Keele University, Stoke on Trent, Staffordshire, U.K

    S. A. Spencer & P. W. Dimmock

  3. Academic Department of Medical Physics, North Staffordshire NHS, Trust/Keele University, Stoke on Trent, Staffordshire, U.K

    Y. A. B. D. Wickramasinghe & P. Rolfe

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  1. S. L. Watkin
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  2. S. A. Spencer
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  3. P. W. Dimmock
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  4. Y. A. B. D. Wickramasinghe
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  5. P. Rolfe
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Watkin, S.L., Spencer, S.A., Dimmock, P.W. et al. A Comparison of Pulse Oximetry and Near Infrared Spectroscopy (NIRS) in the Detection of Hypoxaemia Occurring With Pauses in Nasal Airflow in Neonates. J Clin Monit Comput 15, 441–447 (1999). https://doi.org/10.1023/A:1009938225495

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