Oxygen Saturation Measurements in Newborns

Primary Clinical Significance

Pre-ductal and post-ductal oxygen saturation measurements are essential for detecting critical congenital heart disease (CCHD), guiding oxygen therapy during resuscitation, and identifying other serious cardiopulmonary conditions in newborns 1

Pre-ductal oxygen saturation measurements are taken from the right upper extremity (wrist or medial palm) and reflect oxygen saturation before the ductus arteriosus 2, 3

Screening for CCHD should be performed at approximately 24 hours of life using simultaneous pre- and post-ductal measurements, with abnormal results defined as oxygen saturation <95% in both pre- and post-ductal sites, or a >3% difference between pre- and post-ductal measurements, or any single measurement <90% 1
The American Academy of Pediatrics recommends that failed screening requires immediate echocardiography to rule out cardiac causes 1
The American Heart Association recommends that oxygen therapy during neonatal resuscitation should be titrated to achieve pre-ductal saturations matching the interquartile range of healthy term infants 4, 5, 6
The American Academy of Pediatrics recommends that term/late-preterm (≥35 weeks) newborns should start with 21% oxygen (room air) during resuscitation, while preterm (<35 weeks) newborns should start with 21-30% oxygen 4, 7, 8, 5, 6
The American Heart Association recommends that 100% oxygen is not recommended for term/late-preterm infants (Class 3: Harm) 7, 9

The American Academy of Pediatrics recommends that pre-ductal monitoring requires right upper extremity placement to appropriately compare to published normative data 2, 3
Modern neonatal pulse oximeters provide reliable readings within 1-2 minutes after birth 2, 3

The American Academy of Pediatrics recommends that CCHD should not be ruled out based solely on normal screening, as false negatives occur, and pulse oximetry sensitivity for CCHD is only 50-76% 1
The American Heart Association recommends that 100% oxygen should not be used for initial resuscitation of term infants, as this causes harm 7, 9