Pulse oximetry used for documenting oxygen saturation and right-to-left shunting immediately after birth

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Abstract
The objective of this study was to investigate the clinical applicability of pulse oximetry to measure haemoglobin oxygen saturation and heart rate in the first 20 min of life and to analyse the effect of pre- or postductal (hand, respectively, foot) fixation of sensors on oxygen saturation. Measurements were carried out on 53 newborn infants selected at random after delivery by caesarean section. Signal detection occurred significantly faster from the hand (50% after 1.3 min, 90% after 4 min) than from the foot (50% after 3.1 min, 90% after 9 min). Both fixation sites showed equally great sensitivity to motion. The heart rates from pulse oximetry recordings were up to 30% lower than those from ECG recordings. Saturation values from the hand were nearly always higher than those from the foot (median difference in the 5th min was 10%; between the 5th and 10th min it was 7%; no significant difference occurred after the 17th min). We conclude that pulse oximetry can be used for documenting oxygenation and right-to-left shunting in newborn infants during the first minutes of life in spite of limitations due to incomplete pulse wave detection and artifacts.