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©The Author(s) 2024.
World J Clin Pediatr. Sep 9, 2024; 13(3): 96950
Published online Sep 9, 2024. doi: 10.5409/wjcp.v13.i3.96950
Published online Sep 9, 2024. doi: 10.5409/wjcp.v13.i3.96950
Table 1 The challenges facing using pulse oximetry in children and how to overcome them
Problem | Suggested solution |
Children have smaller fingers and earlobes | Use specialized sensors designed for pediatric use. These are smaller in size and may include adhesive attachments to secure them properly on the child’s finger, toe, or other appropriate site |
Increased risk of movement during monitoring | Ensure careful positioning of the sensor and minimize patient movement during measurement to prevent motion artifacts that could affect the accuracy of pulse oximetry readings |
Variation in skin pigmentation | Be aware that darker skin tones can absorb more light, potentially leading to lower readings. If necessary, consider appropriate adjustments or alternative monitoring sites to account for skin pigmentation differences |
Lower peripheral perfusion in pediatric patients | Choose a monitoring site with better perfusion or use pulse oximetry in conjunction with clinical assessment to ensure accurate monitoring, especially in neonates and infants |
Specific calibration settings for pediatric oximeters | Ensure that pulse oximeters used in pediatric settings are appropriately calibrated to obtain accurate readings, with calibration settings tailored to the age and size of the patient population |
Consideration of clinical factors in interpretation | Contextualize SpO2 readings within the overall clinical picture, considering the child’s age, clinical condition, and baseline oxygen saturation levels for accurate assessment and appropriate intervention |
Table 2 The preferred placement sites for pulse oximeter probes in neonates, infants, and children
Age group | Preferred placement sites |
Neonates | The palm of the hand (preferred) |
Sole of the foot (if palm reading is difficult) | |
Wrist | |
Ankle | |
Infants | Finger (index finger preferred, followed by thumb, middle finger, and great toe), nose, earlobe, forehead |
Children | Finger (index finger preferred, followed by thumb, middle finger, and great toe), nose, earlobe, forehead |
Table 3 Clinical indications of pulse oximetry in neonates, infants, and children
Clinical application | Description |
Neonatal indications | |
Fetal and neonatal care | Pulse oximetry can continuously monitor oxygen saturation during delivery and in neonates with respiratory distress syndrome, congenital heart defects, or other respiratory conditions |
Newborn screening for CCHD | Pulse oximetry screening detects CCHD in newborns by comparing SpO2 readings between the upper and lower extremities, indicating the presence of heart defects |
RDS | Pulse oximetry assesses oxygenation and monitors respiratory status in preterm infants with RDS, guiding oxygen therapy and evaluating response to treatment |
BPD | Pulse oximetry monitors oxygenation and respiratory status in infants with BPD, guiding oxygen therapy, detecting complications, and assessing response to interventions |
Apnea of prematurity | Pulse oximetry detects oxygen desaturation events associated with apnea in premature infants, allowing for prompt intervention and monitoring of respiratory status |
PPHN | Pulse oximetry assesses oxygenation and monitors response to treatment in infants with PPHN, guiding oxygen therapy and evaluating the effectiveness of interventions |
Neonatal methemoglobinemia | Pulse oximetry may underestimate O2 saturation in neonatal methemoglobinemia, prompting further investigation and monitoring of response to treatment |
Postoperative care | Pulse oximetry monitors O2 saturation levels in neonates after surgery, facilitating early detection of respiratory compromise & guiding interventions for optimal recovery |
Infancy and childhood indications | |
Children with respiratory illnesses | Pulse oximetry is essential for managing respiratory illnesses in children. It aids in assessing oxygen saturation levels and the severity of the condition, monitoring oxygen therapy effectiveness, tracking treatment response, and guiding clinical decisions. It provides valuable insights into conditions like pneumonia, bronchiolitis, and asthma exacerbations |
Assessment of circulatory status | Pulse oximetry is significant in evaluating circulatory status in children. It allows for the early detection of circulatory compromise and guides interventions to restore perfusion and prevent organ dysfunction. It also provides real-time feedback on treatment effectiveness, particularly in cases of shock or hypovolemia |
Monitoring during anesthesia and sedation | Pulse oximetry is crucial for monitoring children during anesthesia and sedation. It enables continuous assessment of SpO2 levels and pulse rate. It aids in the early detection of respiratory depression, airway obstruction, and hypoxemia, ensuring patient safety during procedures requiring anesthesia or sedation |
Management of sleep disorders | Pulse oximetry is instrumental in managing childhood sleep disorders such as OSA or central sleep apnea. It facilitates screening, assesses severity, monitors treatment effectiveness, and detects complications. It also enables home monitoring, leading to early treatment failure or disease progression detection |
Evaluation of trauma and critical care | Pulse oximetry assists in the rapid assessment of oxygenation status in children with trauma or critical illness, aiding in the early detection of hypoxemia and respiratory compromise. It provides continuous monitoring during critical care interventions and facilitates timely escalation of care |
Home monitoring | Pulse oximetry is valuable for monitoring various childhood disorders at home, including respiratory conditions, congenital heart diseases, neurological disorders, and neonatal complications. It enables early detection of abnormalities, prompts medical attention, and enhances accessibility to healthcare services when integrated with telemedicine technologies |
Table 4 The diseases or conditions, the problems they pose to pulse oximetry, and potential solutions to address these challenges
Disease/condition | Problem with pulse oximetry | Solution |
Anaemia | Reduced accuracy of SpO2 readings due to lower hemoglobin levels affecting oxygen saturation | Interpret readings cautiously, consider other clinical indicators, and perform arterial blood gas analysis for severe cases |
Polycythaemia | Falsely elevated SpO2 readings due to increased hemoglobin levels and altered blood viscosity | Be aware of potential inaccuracies and consider alternative assessment methods, such as arterial blood gas analysis |
Metabolic derangement | Shifts in the oxygen dissociation curve and peripheral vasoconstriction can affect SpO2 readings | Interpret readings cautiously, consider other clinical parameters, and be aware of acidosis-induced left shifts or alkalosis-induced right shifts |
Cardiac arrhythmia | Irregular blood flow causes fluctuations in pulsatile signal, leading to inaccurate readings | Use pulse oximeters with advanced signal processing algorithms, monitor waveform quality, and consider alternative assessments such as arterial blood gas analysis |
Hypothermia | Reduced peripheral perfusion and altered oxygen dissociation curve affecting SpO2 accuracy | Apply local heating to improve perfusion, use pulse oximeters with enhanced low-perfusion algorithms, and consider supplemental assessments |
Jaundice | Minimal interference from bilirubin with pulse oximetry readings, though COHb may cause inaccuracies | Monitor for COHb levels in severe cases; rely on pulse oximetry for most jaundiced patients |
Electromagnetic field | Interference with pulse oximetry readings from sources such as electrosurgical units and cellular phones | Use fiberoptic pulse oximetry during MRI procedures to minimize exposure to electromagnetic fields |
Table 5 General guidelines for effective use of pulse oximetry
Guideline | Details |
Sensor placement | Place on well-perfused areas (finger, toe, earlobe) based on the child’s age and size |
Sensor securement | Secure snugly but not too tightly to prevent motion artifacts and ensure optimal signal quality |
Establish baseline | Establish a baseline oxygen saturation level for each patient to interpret subsequent readings accurately |
Considerations | The expected oxygen saturation range should be determined based on age, baseline respiratory status, and underlying medical conditions |
Continuous monitoring | Continuous monitoring should be used in critically ill or high-risk patients to promptly detect changes in oxygen saturation |
Additional parameters | Monitor respiratory rate, heart rate, level of consciousness, and skin color alongside oxygen saturation levels |
Minimizing artifacts | Minimize patient movement, ensure proper sensor placement, and use immobilization techniques or sedation as needed to reduce motion artifacts |
Equipment maintenance | Regularly monitor and address technical issues and calibrate equipment according to manufacturer’s guidelines |
Sensor replacement | Replace sensors as needed to maintain accuracy and reliability |
Alternative sites | Alternative sensor placement sites (forehead or palm) should be used for patients with poor peripheral perfusion or compromised circulation |
Trend monitoring | Monitor trends in oxygen saturation over time rather than relying solely on individual readings |
Education | Educate parents, caregivers, and healthcare staff about the importance of pulse oximetry and proper sensor placement |
Documentation | Document pulse oximetry readings, relevant clinical information, and interventions in the patient’s medical record |
Optimization | Every effort should be made to optimize pulse oximetry monitoring effectiveness, improving patient outcomes and care quality |
- Citation: Al-Beltagi M, Saeed NK, Bediwy AS, Elbeltagi R. Pulse oximetry in pediatric care: Balancing advantages and limitations. World J Clin Pediatr 2024; 13(3): 96950
- URL: https://www.wjgnet.com/2219-2808/full/v13/i3/96950.htm
- DOI: https://dx.doi.org/10.5409/wjcp.v13.i3.96950