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Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context
  1. Patrick James Berkeley Walker1,2,
  2. Ayobami Adebayo Bakare3,4,
  3. Adejumoke Idowu Ayede3,
  4. Rosena Olubanke Oluwafemi5,
  5. Omolayo Adebukola Olubosede6,
  6. Iyabo Victoria Olafimihan7,
  7. Kenneth Tan8,9,
  8. Trevor Duke10,11,
  9. Adegoke Gbadegesin Falade12,13,
  10. Hamish Graham14
  1. 1 Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
  2. 2 Medicine, Nursing & Health Sciences, Monash University, Clayton, Victoria, Australia
  3. 3 Department of Paediatrics, University of Ibadan, Ibadan, Nigeria
  4. 4 University College Hospital Ibadan, Ibadan, Nigeria
  5. 5 Department of Neonatology, Mother and Child Hospital, Akure, Nigeria
  6. 6 Teaching Hospital Complex, University of Medical Sciences, Akure, Nigeria
  7. 7 Department of Paediatrics, Sacred Heart Hospital, Abeokuta, Nigeria
  8. 8 Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
  9. 9 Monash Newborn, Monash Children's Hospital, Melbourne, Victoria, Australia
  10. 10 Intensive Care Unit and University of Melbourne Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
  11. 11 Department of Child Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
  12. 12 College of Medicine, University of Ibadan, Ibadan, Nigeria
  13. 13 Department of Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
  14. 14 Centre for International Child Health, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
  1. Correspondence to Dr Patrick James Berkeley Walker, Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3056, Australia; patrickjbwalker{at}


Objective To evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting.

Design and setting Prospective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO2 monitoring.

Patients We recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period.

Main outcome measures Proportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO2 range of 90%–95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%–100%.

Results Preterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO2 range of 90%–95%. They spent 75.0% (63.6–81.1) of time above 95%, and 2.7% (1.7–5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%–100%, and 0.9% (0.3–1.4) of time below 85%. Guidelines recommended SpO2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively.

Conclusions To better maintain SpO2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO2 5.3 times per day appears suitable.

  • oxygen
  • oximetry
  • neonatology
  • SpO2
  • low-resource

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  • Contributors PJBW, HG, TD, KT and AGF conceived and designed the study. PJBW, HG, AAB, AIA, ROO, OAO, IVO and AGF participated in project implementation. PJW and AAB were responsible for data collection. PJBW, HG and AAB contributed to data analysis and interpretation of results. PJBW drafted the manuscript. HG, TD and AGF provided substantial comments to the writing of the manuscript. All authors read and approved the final manuscript.

  • Funding The funders of the study include the Bill and Melinda Gates Foundation (financial support for the Nigeria Oxygen Implementation Project, in which this study is nested; OPP1123577), Masimo Corporation (provision of 10 Radical-7 CO-Oximeters, probes, and one Windows laptop computer) and the Murdoch Children’s Research Institute ($A500 scholarship to support PJBW’s involvement). All authors had full access to all the data in the study, and had final responsibility for the decision to submit for publication.

  • Disclaimer The funders played no role in study design, data collection, data analysis, data interpretation or writing of this report.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study obtained approval from the ethics committees at the University of Melbourne (Ethics ID 1748914), Monash University (Project Number 9398) and the University College Hospital/University of Ibadan (Ethics Committee Assigned Number UI/EC/16/0413).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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