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Pulse oximetry for monitoring infants in the delivery room: a review
  1. J A Dawson,
  2. P G Davis,
  3. C P F O’Donnell,
  4. C O F Kamlin,
  5. C J Morley
  1. Division of Neonatal Services, The Royal Women’s Hospital, Melbourne, Victoria, Australia
  1. Correspondence to:
    J Dawson
    Division of Neonatal Services, Royal Women’s Hospital, Melbourne, 132 Grattan Street, Carlton, Victoria 3053, Australia; jennifer.dawson{at}

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During the first few minutes of life, oxygen saturation (saturation by pulse oximetry, SpO2) increases from intrapartum levels of 30–40%.1 In algorithms for neonatal resuscitation published by the International Liaison Committee for Resuscitation,2 European Resuscitation Council3 and Australian Resuscitation Council,4 clinical assessment of an infant’s colour (a measure of oxygenation) and heart rate are used as major action points. However, studies have shown that clinical assessment of colour during neonatal transition is unreliable.5,6 O’Donnell et al6 showed that the SpO2 at which observers perceived infants to be pink varied widely, ranging from 10% to 100%. Assessing colour is difficult and therefore is a poor proxy for tissue oxygenation during the first few minutes of life.

Kattwinkel7 suggested pulse oximetry may help achieve normoxia in the delivery room. The American Heart Association8 suggests that “administration of a variable concentration of oxygen guided by pulse oximetry may improve the ability to achieve normoxia more quickly”. Although “normoxia” and an acceptable time to achieve this during neonatal transition have not been defined, Leone and Finer9 advocate a target “SpO2 of 85 to 90% by three minutes after birth for all infants except in special circumstances”—for example, diaphragmatic hernia or cyanotic congenital heart disease. International surveys show that oximetry is increasingly used during neonatal resuscitation.10,11

To date, there are no evidence-based guidelines for using oximetry to measure an infant’s SpO2 and to guide interventions during neonatal transition after birth. We reviewed the literature to evaluate the evidence on the use of SpO2 measurements immediately after birth.


Pulse oximetry measures SpO2 continuously and non-invasively, without the need for calibration, and correlates closely with arterial oxygen saturation.12 Pulse oximetry is based on the red and infrared light-absorption …

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  • Supported in part by a RWH Postgraduate degree scholarship (CPFOD and COFK) and a NHMRC Practitioner Fellowship (PGD).

  • Competing interests: None.

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