Elsevier

The Journal of Pediatrics

Volume 135, Issue 5, November 1999, Pages 580-586
The Journal of Pediatrics

Longitudinal assessment of hemoglobin oxygen saturation in healthy infants during the first 6 months of age,☆☆,

Presented in part at the Annual Meeting of the Pediatric Academic Societies, Washington, DC, May 2-6, 1997, and the Fifth International SIDS Conference, Rouen, France, April 20-23, 1998.
https://doi.org/10.1016/S0022-3476(99)70056-9Get rights and content

Abstract

Limitations in home monitoring technology have precluded longitudinal studies of hemoglobin oxygen saturation during unperturbed sleep. The memory monitor used in the Collaborative Home Infant Monitoring Evaluation addresses these limitations. We studied 64 healthy term infants at 2 to 25 weeks of age. We analyzed hemoglobin oxygen saturation by pulse oximetry (SpO2), respiratory inductance plethysmography, heart rate, and sleep position during 35,127 epochs automatically recorded during the first 3 minutes of each hour. For each epoch baseline SpO2 was determined during ≥10 s of quiet breathing. Acute decreases of at least 10 saturation points and <90% for ≥5 s were identified, and the lowest SpO2 was noted. The median baseline SpO2 was 97.9% and did not change with age or sleep position. The baseline SpO2 was <90% in at least 1 epoch in 59% of infants and in 0.51% of all epochs. Acute decreases in SpO2 occurred in 59% of infants; among these, the median number of episodes was 4. The median lowest SpO2 during an acute decrease was 83% (10th, 90th percentiles 78%, 87%); 79% of acute decreases were associated with periodic breathing, and ≥16% were associated with isolated apnea. With the use of multivariate analyses, the odds of having an acute decrease increased as the number of epochs with periodic breathing increased, and they lessened significantly with age. We conclude that healthy infants generally have baseline SpO2 levels >95%. The transient acute decreases are correlated with younger age, periodic breathing, and apnea and appear to be part of normal breathing and oxygenation behavior. (J Pediatr 1999;134:580-6)

Section snippets

METHODS

The healthy term infants enrolled in the CHIME study were born at 38 to 42 weeks’ gestation. All were appropriate for gestational age, were normal at delivery, were discharged with the mother, and were ≤30 days old at enrollment. The exclusion criteria included any acute illness and a family history of sudden infant death syndrome. Written informed consent was obtained for each infant, and the Institutional Review Board at each site approved the study.

Among the 214 healthy term infants enrolled

RESULTS

The 64 infants in this study were compared with the 150 healthy term infants not included (Table).

Table. Characteristics of the mothers of healthy term infants and infant characteristics compared with the total CHIME group of healthy term infants

Group characteristicsStudy group (≥50 h/mo for ≥3 mo) (n = 64)Comparison (insufficient monitor use) (n = 150)
Maternal characteristics
 Age*31.8 (5.7)28.8 (6.1)
 Education*15.9 (2.9)14.4 (2.7)
 Race/ethnic group*
  % White64.147.3
  % Black3.121.6
  % Hispanic7.88.1
  %

DISCUSSION

The features of the CHIME monitor enabled recording of 35,127 3-minute observations unaffected by monitor alarms or other systematic perturbations and have yielded new insights into baseline and acute decreases in SpO2. Infants with ≥1 low baseline SpO2 were more likely to have ≥1 acute decrease in SpO2. The acute decreases improve with age and are primarily associated with periodic breathing; periodic breathing is more common in nonprone sleeping positions. Because the periodic breathing,

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The CHIME study is supported by National Institute of Child Health and Human Development HD: 29067, 29071, 28971, 29073, 29060, 29056, and 34625.

☆☆

Reprint requests: Carl E. Hunt, MD, Department of Pediatrics, Medical College of Ohio, Toledo, OH 43614-2598.

0022-3476/99/$8.00 + 0  9/21/101362

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