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The precision and accuracy of Nellcor and Masimo oximeters at low oxygen saturations (70%) in newborn lambs
  1. J A Dawson1,2,3,
  2. P Bastrenta4,
  3. F Cavigioli4,
  4. M Thio1,3,5,
  5. T Ong6,
  6. M L Siew6,7,
  7. S B Hooper6,7,
  8. P G Davis1,2,3
  1. 1Newborn Research Centre, The Royal Women's Hospital, Melbourne, Victoria, Australia
  2. 2Neonatal Research, The Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
  3. 3Department of Obstetrics & Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
  4. 4Neonatology Department, V. Buzzi Hospital, Milan, Italy
  5. 5Neonatology Department, Hospital St Joan de Déu, Barcelona, Spain
  6. 6The Ritchie Centre, Monash Institute for Medical Research, Melbourne, Victoria, Australia
  7. 7Department of Obstetrics & Gynaecology, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Jennifer Dawson, Newborn Research Centre, The Royal Women's Hospital, Corner Grattan Street and Flemington Road, Parkville, VIC 3052, Australia; jennifer.dawson{at}


Background Administration of oxygen in the delivery room is informed by oxygen saturation (SpO2). An oxygen saturation range of 60%–70% is the threshold for administering oxygen in the first minutes after birth. The accuracy of newer generation oximeters to measure SpO2 has not been compared against the ‘gold standard’, direct arterial blood oxygen saturation (SaO2) when SaO2 is low. The aim of this study was to determine the accuracy and precision of Nellcor and Masimo oximeters to measure SpO2 when SaO2 <70%.

Method Prospective observational study in ventilated anaesthetised newborn lambs with an indwelling carotid artery catheter. Ventilation was adjusted to achieve hypoxaemia. Nellcor (Oxi-Max 600 with Max-N sensor) and Masimo (Rad 4 with low noise optical probe (LNOP) sensor) sensors were applied to the right forelimb (preductal). An arterial blood sample was collected at 1–5 min intervals when the animal was hypoxic. The displayed SpO2 was recorded. We used Bland–Altman analysis to determine precision and accuracy of each oximeter when SaO2 <70%.

Results 17 lambs were studied, 165 measurements were obtained, 123 were SaO2 <70%. The mean difference (±1.96 SD) Nellcor SpO2-SaO2 when SaO2 <70% was 17% (−12% to 46%). The mean difference (±1.96 SD) Masimo SpO2-SaO2 when SaO2 <70% was 13% (−19% to 45%).

Conclusions At SaO2<70%, both monitors overestimated oxygen saturation (SpO2) compared with the gold standard. Both oximeters were equally inaccurate when SaO2 was low.

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