Original article
Pre-ductal and Post-ductal O2 Saturation in Healthy Term Neonates after Birth

https://doi.org/10.1016/j.jpeds.2006.12.015Get rights and content

Objective

To determine the pre- and post-ductal oxygen saturation (SpO2) levels during the first minutes after birth in healthy term infants.

Study design

In a prospective cohort study, sensors were placed on the right hand and on 1 foot of the neonate. Pre- and post-ductal SpO2 levels were recorded during the first 15 minutes after birth. Exclusion criteria were gestational age <37 weeks, presence of risk factors for asphyxia, emergency cesarean delivery (C/D), congenital anomalies, and multiple pregnancies. Infants who were treated with O2 or positive pressure ventilation were also excluded from the study.

Results

The mean (SD) gestational age of the 110 infants was 39 weeks (1.1), and the mean birth weight was 3340 grams (359). At 5 minutes, the mean pre-ductal SpO2 level was 89% (7), and the mean post-ductal SpO2 level was 81% (10). Pre- and post-ductal SpO2 levels were significantly different during the first 15 minutes after birth. The SpO2 level was lower in babies delivered by C/D in comparison to babies born by vaginal delivery.

Conclusions

In healthy newly born infants, oxygen saturation rises slowly and does not usually reach 90% in the first 5 minutes of life. A gradient between pre- and post-ductal SpO2 levels remains significant for the first 15 minutes of life.

Section snippets

Methods

This was a prospective cohort study. The population consisted in healthy term newly born infants born by vaginal delivery or cesarean delivery (C/D). Exclusion criteria are shown in Table I.

For the purpose of the study, 2 investigators and a resident attended every delivery. A second- or third-year resident received the baby and gave all the initial care, and 2 additional physicians (neonatology fellows or attendings) took care of the sensors, monitors, chronometer, and data recording (from

Results

Between Oct 10 and Nov 28 2005, 214 babies were born at our institution. Of these births, 104 infants were excluded from the study, for these reasons: 23 were preterm (<37 weeks), 21 had risk factors for asphyxia, 3 were born by emergency C/D, 2 had congenital anomalies, 4 were twin gestations, 8 needed resuscitation, 3 had parents who denied consent, 22 had parents whom the investigators were unable to approach to obtain informed consent, and 18 were excluded for other reasons (simultaneous

Discussion

Our study demonstrates that, in healthy newborn infants immediately after birth, there is a significant difference between pre-ductal and post-ductal SpO2 levels during the first 15 minutes of life. Most likely this is caused by high pulmonary artery pressure and right-to-left shunt through the ducts arteriosus. Both pre- and post-ductal SpO2 levels rise gradually and do not usually reach 90% in the first 5 minutes of life. The use of monitors with signal extraction technology makes the

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