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Pulse oximetry in neonates at high altitudes: a modified Colorado protocol

Published online by Cambridge University Press:  20 January 2020

Julien I. E. Hoffman Open the ORCID record for Julien I. E. Hoffman [Opens in a new window]
Julien I. E. Hoffman*
Affiliation:
Department of Pediatrics, University of California, San Francisco, CA, USA
*
Author for correspondence: J. I. E. Hoffman, 925 Tiburon Boulevard, Tiburon, CA94920, USA. Tel: +1 415 697 6741; Fax: +1 415 380 5013; E-mail: [email protected]
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Abstract

Pulse oximetry for detecting critical CHD produces more false positive tests at high altitudes than at sea level, because at altitude the average resting saturation is lower and the variability is higher. This increases diagnostic difficulties, especially in small isolated communities without paediatric echocardio-graphy, and requires expensive transport to a regional medical centre. One way of reducing diagnostic errors is to measure arterial oxygen saturation while the infant is breathing 100% oxygen. In the absence of right-to-left shunting through the heart, the ductus, or the lungs, arterial oxygen tension will exceed 150 mmHg and arterial oxygen saturation will be 100%. With right-to-left shunting, arterial oxygen tension will be <100 mmHg, and thus <96% (usually much lower).

Keywords

Fetal haemoglobinalveolar oxygen concentrationalveolar–arterial gradient
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 2 , February 2020 , pp. 177 - 179
Copyright
© Cambridge University Press 2020

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References

Subhi, R, Smith, K, Duke, TWhen should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxaemia. Arch Dis Child 2009; 94: 6–1010.1136/adc.2008.138362CrossRefGoogle ScholarPubMed
Wright, J, Kohn, M, Niermeyer, S, Rausch, CMFeasibility of critical congenital heart disease newborn screening at moderate altitude. Pediatrics 2014; 133: e561–e569CrossRefGoogle ScholarPubMed
Hoffman, JIIs pulse oximetry useful for screening neonates for critical congenital heart disease at high altitudes? Pediatr Cardiol 2016; 37: 812–81710.1007/s00246-016-1371-1CrossRefGoogle ScholarPubMed
Niermeyer, S, Yang, P, Shanmina, , Drolkar, , Zhuang, J, Moore, LGArterial oxygen saturation in Tibetan and Han infants born in Lhasa, Tibet. N Engl J Med 1995; 333: 1248–125210.1056/NEJM199511093331903CrossRefGoogle Scholar
Huicho, LPostnatal cardiopulmonary adaptations to high altitude. Respir Physiol Neurobiol 2007; 158: 190–20310.1016/j.resp.2007.05.004CrossRefGoogle ScholarPubMed
Storz, JF, Moriyama, HMechanisms of hemoglobin adaptation to high altitude hypoxia. High Alt Med Biol 2008; 9: 148–15710.1089/ham.2007.1079CrossRefGoogle ScholarPubMed
Wikipedia. Large cities with high elevation in the world, 2012.Google Scholar
Rahn, H, Fenn, WOA Graphical Analysis of the Respiratory Gas Exchange. American Physiological Society, Washington, DC, 1955.Google Scholar
Nelson, NM, Prod’Hom, LS, Cherry, RB, Lipsitz, PJ, Smith, CAPulmonary function in the newborn infant: the alveolar-arterial oxygen gradient. J Appl Physiol 1963; 18: 534–53810.1152/jappl.1963.18.3.534CrossRefGoogle ScholarPubMed
Oski, FAClinical implications of the oxyhemoglobin dissociation curve in the neonatal period. Crit Care Med 1979; 7: 412–41810.1097/00003246-197909000-00013CrossRefGoogle ScholarPubMed
Jones, RW, Baumer, JH, Joseph, MC, Shinebourne, EAArterial oxygen tension and response to oxygen breathing in differential diagnosis of congenital heart disease in infancy. Arch Dis Child 1976; 51: 667–673CrossRefGoogle ScholarPubMed
Shannon, DC, Lusser, M, Goldblatt, A, Bunnell, JBThe cyanotic infant–heart disease or lung disease. N Engl J Med 1972; 287: 951–95310.1056/NEJM197211092871903CrossRefGoogle ScholarPubMed
Lueth, E, Russell, L, Duster, M, et al.A novel approach to critical congenital heart disease (CCHD) screening at moderate altitude. Int J Neonatal Screen 2016; 2: 4.CrossRefGoogle Scholar
Tooley, WH, Stanger, PThe blue baby–circulation or ventilation or both? N Engl J Med 1972; 287: 983–98410.1056/NEJM197211092871913CrossRefGoogle ScholarPubMed