Project Lead(s): Daniel Roth
Hypoxemia can occur in young infants with severe acute illnesses or congenital cardiac anomalies, but is not reliably detected on physical exam.
Pulse oximetry (PO) is widely used to detect hypoxemia but its application in low-income countries has been limited, and its feasibility in the routine assessment of young infants (aged newborn to 59 days) has not been previously studied.
The aim of this study was to characterize the operational feasibility and parent/guardian acceptability of incorporating PO into the routine clinical assessment of young infants in a primary care setting in a low-income country. This was a cross-sectional study of 862 visits by 529 infants at two primary care clinics in Karachi, Pakistan (March to June, 2013).
After clinical assessment, oxygen saturation (Sp02) was measured by a handheld PO device (Rad-5v, Masimo Corporation) according to a standardized protocol.
Performance time (PT) was the time between sensor placement and attainment of an acceptable reading (i.e., stable SpO2 + 1 % for at least 10 s, heart rate displayed, and adequate signal indicators). PT included the time for one repeat attempt at a different anatomical site if the first attempt did not yield an acceptable reading within one minute. Parent/guardian acceptability of PO was based on a questionnaire and unprompted comments about the procedure. All infants underwent physician assessment.
Acceptable PO readings were obtained in ≤1 minute at 94.4% and 99.8% of visits, respectively (n = 862).Median PT was 42 s (interquartile range 37; 50). Parents/guardians overwhelmingly accepted PO (99.6% overall satisfaction, n = 528 first visits).
Of the ten infants with at least one visit with Sp02 <92% on a first PO attempt, three did not have a significant acute illness on physician assessment. There were no PO-related adverse events.
The procedure was readily integrated into existing assessment pathways and parents/guardians had positive views of the technology.
Future research is needed to determine if the introduction of routine PO screening of young infants will improve outcomes in low-resource settings.