Original article
Oxygen saturation trends immediately after birth

https://doi.org/10.1016/j.jpeds.2005.12.047Get rights and content

Objective

To describe the changes in oxygen saturation (SpO2) in healthy infants during the first 10 minutes of life.

Study design

In this observational study, infants ≥ 35 weeks gestation at birth who did not require supplemental oxygen had continuous recordings taken of the preductal SpO2 over the first 10 minutes of life.

Results

A total of 115 infants were analyzed. On average, infants delivered by cesarean delivery had a 3% lower SpO2 than infants delivered by vaginal delivery (95% confidence interval [CI] = -5.8 to -0.7; P = .01). Infants born by cesarean delivery also took longer (risk ratio, 1.79) to reach a stable SpO2 ≥ 85% (95% CI = 1.02 to 3.14; P = .04). At 5 minutes of age, median SpO2 values (interquartile range) were 87% (80% to 95%) for infants delivered vaginally and 81% (75% to 83%) for those delivered through cesarean section. The median SpO2 did not reach 90% until 8 minutes of age in either group.

Conclusions

The process of transitioning to a normal postnatal oxygen saturation requires more than 5 minutes in healthy newborns breathing room air.

Section snippets

Subjects

This study design was approved by the research ethics board at our institution. Informed consent was not obtained from the parents because no changes were made to the normal resuscitation protocol apart from applying a sensor probe. The pulse oximetry display was covered so as not to influence the actions of the resuscitation team, and no personally identifying information was collected. The study was conducted in a regional level III neonatal intensive care unit that performs approximately

Results

We collected data from 164 newborns between September 2004 and April 2005. Data from 49 newborns were excluded because these newborns received oxygen supplementation at the time of birth. A summary of patient characteristics is presented in the Table. All of the newborns were ≥ 35 weeks gestation at birth. Subsequent results refer only to the 115 newborns included in the analyses.

Deletion of data not meeting the prespecified criteria as described in the Methods section resulted in the inclusion

Discussion

The transition from a parallel circulation in utero to an in-series circulation after birth results in a higher arterial oxygen content. The time required for this increase in oxygenation is partly dependent on the presence of residual cardiopulmonary shunts. We found that it took up to 8 minutes to reach a median SpO2 of 90%; other studies have reported times of between 8 and 15 minutes.4, 7, 8 Our results support the assertion that during normal neonatal transition, it often takes 8 minutes

References (16)

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Masimo Corporation supplied, on loan, the pulse oximeters and saturation probes used in this study. The study investigators chose to use the Masimo pulse oximeters because of the favorable performance profile for infants in the literature. They did not receive any monetary compensation from Masimo and retain ownership and full rights over the data and decisions regarding publication. Masimo was in no way involved in the data collection, study analyses, study design, or preparation of the manuscript. The first draft of the manuscript was written by Yacov Rabi and Sophie Chen (Methods and Results), Wendy Yee (Introduction), and Nalini Singhal (Discussion). All 4 authors contributed to all sections of the second draft.

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