Oxygen saturation in healthy infants immediately after birth

doi:10.1016/j.jpeds.2005.12.050

The Journal of Pediatrics

Volume 148, Issue 5, May 2006, Pages 585-589

https://doi.org/10.1016/j.jpeds.2005.12.050 Get rights and content

Objective

Because the optimal concentration of oxygen (FiO₂) required for stabilization of the newly born infant has not been established, the FiO₂ is commonly adjusted according to the infant’s oxygen saturation (SpO₂). We aimed to determine the range of pre-ductal SpO₂ in the first minutes of life in healthy newborn infants.

Study design

We applied an oximetry sensor to the infant’s right palm or wrist of term and preterm deliveries immediately after birth. Infants who received any resuscitation or supplemental oxygen were excluded. SpO₂ was recorded at 60 second intervals for at least 5 minutes and until the SpO₂ was >90%.

Results

A total of 205 deliveries were monitored; 30 infants were excluded from the study. SpO₂ readings were obtained within 60 seconds of age from 92 of 175 infants (53%). The median (interquartile range) SpO₂ at 1 minute was 63% (53%-68%). There was a gradual rise in SpO₂ with time, with a median SpO₂ at 5 minutes of 90% (79%-91%).

Conclusion

Many newborns have an SpO₂ <90% during the first 5 minutes of life. This should be considered when choosing SpO₂ targets for infants treated with supplemental oxygen in the delivery room.

Section snippets

Methods

We conducted a prospective observational study of SpO₂ in newly born infants between May 2004 and April 2005. The study was endorsed by the Human Research and Ethics Committees of the Royal Women’s Hospital, Melbourne, Australia. Verbal parental consent for the study was obtained before delivery. The investigating team was not involved in the care of the infants in the delivery room.

Infants ≥31 weeks gestation who were not anticipated to need resuscitation were studied when an investigator was

Results

A total of 205 deliveries were attended. Figure 1 shows the characteristics of infants who were excluded (n = 30) and infants who were included (n = 175). Technical difficulties obtaining data occurred in 12 term infants, none of whom was resuscitated or given supplemental oxygen. Patient characteristics and the time taken for sensor application and signal detection are shown in Table I.

The median SpO₂ values (IQR) at 1, 2, 3, 4, and 5 minutes were 63% (53%-68%; n = 92), 70% (58%-78%; n = 164),

Discussion

The appropriate FiO₂ to use for neonatal resuscitation is subject to debate. It has been suggested that the FiO₂ could be determined by monitoring infants’ SpO₂ by using pulse oximetry.11, 12 Surveys suggest that many clinicians are already using this approach.13, 14 There is limited information about infants’ SpO₂ in the minutes after birth. Toth et al measured the pre- and post-ductal SpO₂ of 50 vaginally born healthy term infants with an older generation pulse oximeter.¹⁵ They found SpO₂ at

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Preductal SpO₂, HR, and timing of DCC immediately after complete fetal body expulsion were recorded. The pulse-oximeter was adjusted in the right wrist/hand and set at maximal intensity and measurements performed every 2 seconds.
A total of 282 term newborn infants were included. The definitive data set comprised of 70 257 SpO₂ and 79 746 HR measurements. Median and IQR of SpO₂ (%) at 1, 5, and 10 minutes after birth were 77 (68-85), 94 (90-96), and 96 (93-98), respectively. HR (beats per minute) median and IQR at 1, 5, and 10 minutes after birth were 148 (84-170), 155 (143-167), and 151 (142-161), respectively. We found significantly higher SpO₂ for the 10th, 50th, and 90th percentiles compared with the previous reference ranges for the first 5 minutes and HR for the first 1-2 minutes after birth.
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Preterm infants frequently require positive pressure ventilation and oxygen supplementation in the first minutes after birth. It has been shown that the amount of oxygen provided during stabilization, the oxygen load, if excessive may cause hyperoxia, and oxidative damage to DNA. Epidemiologic studies have associated supplementation with pure oxygen in the first minutes after birth with childhood cancer. Recent studies have shown that the amount of oxygen supplemented to preterm infants after birth modifies the epigenome. Of note, the degree of DNA hyper-or hypomethylation correlates with the oxygen load provided upon stabilization. If these epigenetic modifications would persist, oxygen supplied in the first minutes after birth could have long term consequences. Further studies with a robust power calculation and long-term follow up are needed to bear out the long-term consequences of oxygen supplementation during postnatal stabilization of preterm infants.

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: C.O.F.K. and C.P.F.O’D. are recipients of the Royal Women’s Hospital Postgraduate Degree Scholarship. P.G.D. is supported by a National Health and Medical Research Council Fellowship.

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Original articleOxygen saturation in healthy infants immediately after birth

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Pediatr

Clin Perinatol

J Pediatr

Clin Perinatol

J Pediatr

Oxygen saturation in healthy newborn infants immediately after birth measured by pulse oximetry

Arch Gynecol Obstet

Pulse oximetry in asphyxiated newborns in the delivery room

Indian Pediatr

Response to resuscitation of the newbornearly prognostic variables

Acta Paediatr

Pulse oximetry in asphyxiated newborns in the delivery room

Indian Pediatr

Response to resuscitation of the newbornearly prognostic variables

Acta Paediatr

Oxygen saturation in healthy newborn infants immediately after birth measured by pulse oximetry

Arch Gynecol Obstet

Obtaining pulse oximetry data in neonatesa randomised crossover study of sensor application techniques

Arch Dis Child Fetal Neonatal Ed

Use of supplementary equipment for resuscitation of newborn infants at tertiary perinatal centres in Australia and New Zealand

Acta Paediatr

Positive pressure ventilation at neonatal resuscitationreview of equipment and international survey of practice

Acta Paediatr

Original article
Oxygen saturation in healthy infants immediately after birth