PROJECT SUMMARY/ABSTRACT
We propose to assess the correlation between arterial oxygen saturation (SaO2) and peripheral oxygen
saturation measured by pulse oximetry (SpO2) discrepancy and skin pigmentation. Recent data demonstrated
that pulse oximetry devices overestimate SpO2 in darker skin adults. This is less understood in newborns.
However, medical conditions associated with hypoxemia occur more commonly in black infants and the
conditions associated with hyperoxemia occur less frequently in black infants. Thus, raising the question if
pulse oximeters overestimate SpO2 in black infants and falsely putting them in the “safe” zone. We will
measure simultaneous SaO2 and SpO2 among varying degrees of skin pigmentation while accounting for other
physiologic variables such as gestational age, receipt of red blood cells, bilirubin, and sex, to assess the
impact of skin pigmentation on the SaO2-SpO2 discrepancy.
Members of our team have experience with research related to oxygen targeted therapies and pulse
oximetry in newborns. Additionally, our team members have experience working with recorded pulse oximetry
data and have received support from the leading pulse oximeter device company to supply equipment and
sensors for this proposal.
The proposed research is significant because it will answer the question if pulse oximetry bias due to
skin color occurs to a degree that is clinically significant and could cause harm for newborns with darker skin.
Results from this study will inform a larger trial in which we will assess the effect of postnatal age on pulse
oximetry accuracy and multiple oximeters and will impact how pulse oximetry is used for infants of varying skin
color in routine care such CCHD screening, SpO2 targeted care and future clinical trials. Additionally, this is
innovative because it will use readily available SpO2 and SaO2 measurements from infants with varying
degrees of light and dark skin to assess pulse oximeter bias and imprecision and will use a noninvasive device
to measure melanin index to quantify skin pigmentation. Additionally, it will take into consideration other
physiologic impacts on SpO2 such as gestational age, degree of hypoxemia, gender, and red blood cell
transfusion. Through collaboration between two neonatal intensive care units, we will establish the
infrastructure and necessary multidisciplinary relationships that can later be expanded to conduct future
multicenter studies to evaluate the potential disparity from pulse oximeters and how it correlates with skin
pigmentation.