Establishing the reference interval for pulse oxygen saturation in neonates at high altitudes: protocol for a multicentre, open, cross-sectional study

Bo Wang, Chongde Liu, Yanli Yao, Zhihui Lu, Rong Yu, Zhuoma CaiRen, Zhixiu Wang, Runwu Liu, Yazhen Wu, Zhangbin Yu, Bo Wang, Chongde Liu, Yanli Yao, Zhihui Lu, Rong Yu, Zhuoma CaiRen, Zhixiu Wang, Runwu Liu, Yazhen Wu, Zhangbin Yu

Abstract

Introduction: Establishing the reference interval for pulse oxygen saturation (SpO2) is essential for sensitively identifying neonatal hypoxaemia due to various causes. However, the reference interval for high altitudes has not yet been established, and existing studies have many limitations. This study will aim to establish the reference interval for various high altitudes and determine whether preductal and postductal measurements at the same altitude vary.

Methods and analysis: This is a multicentre, open, cross-sectional study, which will begin in February 2022. Approximately 2000 healthy full-term singleton neonates will be recruited from six hospitals (altitude ≥2000 m) in Qinghai Province, China. The participating hospitals will use a uniform pulse oximeter type. The measurements will be performed between 24 hours after birth and discharge. During the measurement, the neonate will be awake and quiet. Preductal and postductal measurements will be performed. The measurement time, site and results will be recorded and input, along with the collected basic information, into the perinatal cloud database. We will carry out strict quality control for basic information collection, measurement and data filing. We will perform descriptive statistics on the distribution range of the collected data, determine the lower limit value of the reference interval for each hospital and the corresponding altitude, perform curve fitting for the lower limit value, use the altitude as a covariate for the function corresponding to the fitted curve, establish the prediction equation and ultimately determine the reference intervals of each high altitude location.

Ethics and dissemination: Our protocol has been approved by the Medical Ethics Committee of all participating hospitals. We will publish our study results in academic conferences and peer-reviewed public journals.

Trial registration number: NCT05115721.

Keywords: ALTITUDE MEDICINE; NEONATOLOGY; PERINATOLOGY.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
A flow chart showing the study plan.

References

    1. Tekleab AM, Sewnet YC. Role of pulse oximetry in detecting critical congenital heart disease among newborns delivered at a high altitude setting in Ethiopia. Pediatric Health Med Ther 2019;10:83–8. 10.2147/PHMT.S217987
    1. Roizen MF, Schreider B, Austin W, et al. . Pulse oximetry, capnography, and blood gas measurements: reducing cost and improving the quality of care with technology. J Clin Monit 1993;9:237–40. 10.1007/BF02886693
    1. Kellerman AL, Cofer CA, Joseph S, et al. . Impact of portable pulse oximetry on arterial blood gas test ordering in an urban emergency department. Ann Emerg Med 1991;20:130–4. 10.1016/S0196-0644(05)81208-9
    1. Hoffman JIE. Is pulse oximetry useful for screening neonates for critical congenital heart disease at high altitudes? Pediatr Cardiol 2016;37:812–7. 10.1007/s00246-016-1371-1
    1. Thilo EH, Park-Moore B, Berman ER, et al. . Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child 1991;145:1137–40. 10.1001/archpedi.1991.02160100069025
    1. Niermeyer S, Shaffer EM, Thilo E, et al. . Arterial oxygenation and pulmonary arterial pressure in healthy neonates and infants at high altitude. J Pediatr 1993;123:767–72. 10.1016/S0022-3476(05)80857-1
    1. Tapia-Rombo CA, Rosales-Cervantes MGI, Saucedo-Zavala VJ, et al. . [Oxygen peripheral saturation using pulse oxymetry among healthy term newborns at Mexico's altitude (2240 m)]. Gac Med Mex 2008;144:207–12.
    1. Han LM, Klewer SE, Blank KM, et al. . Feasibility of pulse oximetry screening for critical congenital heart disease at 2643-foot elevation. Pediatr Cardiol 2013;34:1803–7. 10.1007/s00246-013-0716-2
    1. Samuel TY, Bromiker R, Mimouni FB, et al. . Newborn oxygen saturation at mild altitude versus sea level: implications for neonatal screening for critical congenital heart disease. Acta Paediatr 2013;102:379–84. 10.1111/apa.12155
    1. González-Andrade F, Echeverría D, López V, et al. . Is pulse oximetry helpful for the early detection of critical congenital heart disease at high altitude? Congenit Heart Dis 2018;13:911–8. 10.1111/chd.12654
    1. Guo F, Tang S, Guo T, et al. . Revised threshold values for neonatal oxygen saturation at mild and moderate altitudes. Acta Paediatr 2020;109:321–6. 10.1111/apa.14962
    1. Hoq M, Karlaftis V, Mathews S, et al. . A prospective, cross-sectional study to establish age-specific reference intervals for neonates and children in the setting of clinical biochemistry, immunology and haematology: the HAPPI kids study protocol. BMJ Open 2019;9:e025897. 10.1136/bmjopen-2018-025897
    1. Ravert P, Detwiler TL, Dickinson JK. Mean oxygen saturation in well neonates at altitudes between 4498 and 8150 feet. Adv Neonatal Care 2011;11:412–7. 10.1097/ANC.0b013e3182389348
    1. Bakr AF, Habib HS. Normal values of pulse oximetry in newborns at high altitude. J Trop Pediatr 2005;51:170–3. 10.1093/tropej/fmi026
    1. Salas AA. Pulse oximetry values in healthy term newborns at high altitude. Ann Trop Paediatr 2008;28:275–8. 10.1179/146532808X375431
    1. Wang B, Zhang J, Wu Y-Z, et al. . Reference interval for pulse oxygen saturation in neonates at different altitudes: a systematic review. Front Pediatr 2021;9:771750. 10.3389/fped.2021.771750
    1. Stanton MC, Adriko M, Arinaitwe M, et al. . Intestinal schistosomiasis in Uganda at high altitude (>1400 m): malacological and epidemiological surveys on Mount Elgon and in Fort Portal crater lakes reveal extra preventive chemotherapy needs. Infect Dis Poverty 2017;6:34. 10.1186/s40249-017-0248-8
    1. Moore LG. Human genetic adaptation to high altitude. High Alt Med Biol 2001;2:257–79. 10.1089/152702901750265341
    1. Tian YP, Hu XJ, Ma XJ, et al. . [The distribution and variance of neonatal pulse oxygen saturation at different altitudes]. Zhonghua Yi Xue Za Zhi 2021;101:1410–4. 10.3760/cma.j.cn112137-20200831-02504
    1. Altman DG, Ohuma EO, International Fetal and Newborn Growth Consortium for the 21st Century . Statistical considerations for the development of prescriptive fetal and newborn growth standards in the INTERGROWTH-21st project. BJOG 2013;120(Suppl 2):71–6. 10.1111/1471-0528.12031
    1. Kemper AR, Mahle WT, Martin GR, et al. . Strategies for implementing screening for critical congenital heart disease. Pediatrics 2011;128:e1259–67. 10.1542/peds.2011-1317
    1. Singh A, Ewer AK. Pulse oximetry screening for critical congenital heart defects: a UK national survey. Lancet 2013;381:535. 10.1016/S0140-6736(13)60278-0
    1. Zhao Q-ming, Ma X-jing, Ge X-ling, et al. . Pulse oximetry with clinical assessment to screen for congenital heart disease in neonates in China: a prospective study. Lancet 2014;384:747–54. 10.1016/S0140-6736(14)60198-7
    1. Rao S, Goens MB, Myers OB, et al. . Pulse oximetry screening for detection of congenital heart defects at 1646 m in Albuquerque, New Mexico. Cardiol Young 2020;30:1851–5. 10.1017/S1047951120002899
    1. Morgan MC, Maina B, Waiyego M, et al. . Oxygen saturation ranges for healthy newborns within 24 hours at 1800 m. Arch Dis Child Fetal Neonatal Ed 2017;102:F266–8. 10.1136/archdischild-2016-311813
    1. Thangaratinam S, Brown K, Zamora J, et al. . Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 2012;379:2459–64. 10.1016/S0140-6736(12)60107-X
    1. Jullien S. Newborn pulse oximetry screening for critical congenital heart defects. BMC Pediatr 2021;21:305. 10.1186/s12887-021-02520-7
    1. Plana MN, Zamora J, Suresh G, et al. . Pulse oximetry screening for critical congenital heart defects. Cochrane Database Syst Rev 2018;3:CD011912. 10.1002/14651858.CD011912.pub2
    1. Daftary AS, Jalou HE, Shively L, et al. . Polysomnography reference values in healthy newborns. J Clin Sleep Med 2019;15:437–43. 10.5664/jcsm.7670

Source: PubMed

3
購読する