Evaluation of Oxygenation Index Compared With Oxygen Saturation Index Among Neonates Admitted to the NICU
Evaluation of OI and OSI in Neonates admitted to the NICU
-
Masoud Zadkarami
,
Nahid Sadat-Mirdamadi
,
Amirkamal Hardani
,
Mohammadreza Mirkarimi
,
Mohsen Alisamir
,
Solmaz Heidari
,
Shahriar Barouti
,
Shooka Mohammadi
Abstract
Oxygenation index (OI) based on arterial blood gas (ABG) test is an invasive procedure and requires indwelling arterial lines. However, the oxygen saturation index (OSI) assessed by the pulse oximetry method is simple and noninvasive for monitoring oxygenation saturation in newborn neonates with chronic lung disease. This study aimed to evaluate and compare OI and OSI among neonates in NICU who underwent mechanical ventilation. A cross-sectional study was carried out among fifty neonates (term and preterm) who were admitted to the NICU of Abuzar Hospital in Ahvaz, Iran. All neonates were examined by both ABG and pulse oximetry methods. Approximately 2 cc of arterial blood sample was taken and sent to the laboratory to determine blood gases. At the same time, the level of peripheral capillary oxygen saturation (SpO) was recorded using a pulse oximeter. OI and OSI were calculated according to their formula. Spearman’s correlation, linear regression, and Bland-Altman scatter plot were used to determine the correlation, association, and agreement between OI and OSI, respectively. Of the total 50 neonates, 26 were female. The mean (range) gestational age was 35.28±3.01 (28-39) weeks, and post-neonatal age was 6.05±7.04 (1-25) weeks. There was a linear and significant association and correlation between OI and oxygen OSI (P<0.001), while the Bland-Altman scatter plot confirmed the agreement between them in mean values. Therefore, OSI utilizing pulse oximetry as a noninvasive method can be a substitute for OI in neonates with respiratory failure. It can also reduce workloads and costs.
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19. Kumar D, Super DM, Fajardo RA, Stork EE, Moore JJ, Saker FA. Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 hours of admission. J Perinatol 2004;24:376-81.
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21. Dawson JA, Bastrenta P, Cavigioli F, Thio M, Ong T, Siew ML, et al. The precision and accuracy of Nellcor and Masimo oximeters at low oxygen saturations (70%) in newborn lambs. Arch Dis Child Fetal Neonatal Ed 2014;99:F278-81.
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23. Khemani RG, Thomas NJ, Venkatachalam V, Scimeme JP, Berutti T, Schneider JB, et al. Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit care med 2012;40:1309-16.
24. Castillo A, Sola A, Baquero H, Neira, F, Alvis R, Deulofeut R, et al. Pulse oxygen saturation levels and arterial oxygen tension values in newborns receiving oxygen therapy in the neonatal intensive care unit: is 85% to 93% an acceptable range? Pediatrics 2008;121:882-9.
25. Greenspan JS, Goldsmith JP. Oxygen therapy in preterm infants: hitting the target. Pediatrics 2006;118:1740-1.
26. Kattwinkel J, Perlman JM, Aziz K, et al. Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics 2010;126:e1400-13.
27. Doreswamy SM, Chakkarapani AA, Murthy P. Oxygen saturation index, a noninvasive tool for monitoring hypoxemic respiratory failure in newborns. Indian pediatr 2016;53:432-3.
28. Sant'Anna GM, Keszler M. Developing a neonatal unit ventilation protocol for the preterm baby. Early hum Dev 2012;88:925-9.
29. Khemani RG, Patel NR, Bart III RD, Newth CJ. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest 2009;135:662-8.
30. Khalesi N, Choobdar FA, Khorasani M, Sarvi F, Haghighi Aski B, Khodadost M. Accuracy of oxygen saturation index in determining the severity of respiratory failure among preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med 2021;34:2334-9.
31. Alisamir M, Mirkarimi M, Hajatnia S, Zadkarami M. Evaluation of Non-Invasive Oxygen Saturation Index Compared With Oxygenation Index in Pulmonary and Non-Pulmonary Patients Admitted in PICU. Acta Med Iran 2020;58:78-82.
32. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E. Acute respiratory distress syndrome. JAMA 2012;307:2526-33.
33. Ballard RA, Truog WE, Cnaan A, Martin RJ, Ballard PL, Merrill JD, et al. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med 2006;355:343-53.34.
34. Ghaffaripour H, Mirkarimi M, Hassanzad M, Boloursaz M, Mohammadi S. Evaluation of Inflammatory Biomarkers in Iranian Patients with Cystic Fibrosis. Curr Respir Med Rev 2020;16:184-92.
2. Hug L, Alexander M, You D, Alkema L, for Child UI. National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis. Lancet Glob Health 2019;7:e710-20.
3. Karimi P, Mahmudi L, Azami M, Badfar G. Mortality in Neonatal Intensive Care Units in Iran: A Systematic Review and Meta-Analysis. IJN 2019;10:70-80.
4. Risso SDP. Risk factors for neonatal death in neonatal intensive care unit according to survival analysis. Rev Bras Ter Intensiva 2010;22:19-26.
5. Lau YY, Tay YY, Shah VA, Chang P, Loh KT. Maintaining optimal oxygen saturation in premature infants. Perm J 2011;15:e108.
6. Wyckoff MH, Aziz K, Escobedo MB, Kapadia VS, Kattwinkel J, Perlman JM, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132:S543-60.
7. Kayton A, Timoney P, Vargo L, Perez JA, Harris-Haman PA, Zukowsky K. A review of oxygen physiology and appropriate management of oxygen levels in premature neonates. Adv Neonatal Care 2018;18:98-104.
8. Edwards EM, Horbar JD. Variation in use by NICU types in the United States. Pediatrics 2018;142:e20180457.
9. Schulman J, Braun D, Lee HC, Profit J, Duenas G, Bennett MV, et al. Association between neonatal intensive care unit admission rates and illness acuity. JAMA Pediatr 2018; 172:17-23.
10. Boulais J, Vente T, Daley M, Ramesh S, McGuirl J, Arzuaga B. Concern for mortality in the neonatal intensive care unit (NICU): parent and physician perspectives. J Perinatol 2018;38:718-27.
11. Hadzic D, Zulic E, Alihodzic H, Softic D, Kovacevic D. Oxygen saturation index for assessment of respiratory failure in neonates. Sanamed 2018;13:123-30.
12. Muniraman HK, Song AY, Ramanathan R, Fletcher KL, Kibe R, Ding L, Lakshmanan A, Biniwale M. Evaluation of oxygen saturation index compared with oxygenation index in neonates with hypoxemic respiratory failure. JAMA Netw Open 2019;2:e191179.
13. Yıldızdaş D, Yapıcıoğlu H, Yılmaz HL, Sertdemir Y. Correlation of simultaneously obtained capillary, venous, and arterial blood gases of patients in a paediatric intensive care unit. Arch Dis Child 2004;89:176-80.
14. Shiao SY, Ou CN. Validation of oxygen saturation monitoring in neonates. Am J Crit Care 2007;16:168-78.
15. Van Bel F, Lemmers P, Naulaers G. Monitoring neonatal regional cerebral oxygen saturation in clinical practice: value and pitfalls. Neonatology 2008; 94:237-44.
16. Thomas NJ, Shaffer ML, Willson DF, Shih MC, Curley MA. Defining acute lung disease in children with the oxygenation saturation index. Pediatr Crit Care Med 2010;11:12-7.
17. Barrington KJ, Finer N, Pennaforte T, Altit G. Nitric oxide for respiratory failure in infants born at or near term. Cochrane Database Syst Rev 2017;1:CD000399.
18. Konduri GG, Solimano A, Sokol GM, Singer J, Ehrenkranz RA, Singhal N, et al. A randomized trial of early versus standard inhaled nitric oxide therapy in term and near-term newborn infants with hypoxic respiratory failure. Pediatrics 2004;113:559-64.
19. Kumar D, Super DM, Fajardo RA, Stork EE, Moore JJ, Saker FA. Predicting outcome in neonatal hypoxic respiratory failure with the score for neonatal acute physiology (SNAP) and highest oxygen index (OI) in the first 24 hours of admission. J Perinatol 2004;24:376-81.
20. Nitzan M, Romem A, Koppel R. Pulse oximetry: fundamentals and technology update. Med Devices (Auckl) 2014; 7:231-9.
21. Dawson JA, Bastrenta P, Cavigioli F, Thio M, Ong T, Siew ML, et al. The precision and accuracy of Nellcor and Masimo oximeters at low oxygen saturations (70%) in newborn lambs. Arch Dis Child Fetal Neonatal Ed 2014;99:F278-81.
22. Khemani RG, Rubin S, Belani S, Leung D, Erickson S, Smith LS, et al. Pulse oximetry vs. PaO 2 metrics in mechanically ventilated children: Berlin definition of ARDS and mortality risk. Intensive Care Med 2015;41:94-102.
23. Khemani RG, Thomas NJ, Venkatachalam V, Scimeme JP, Berutti T, Schneider JB, et al. Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit care med 2012;40:1309-16.
24. Castillo A, Sola A, Baquero H, Neira, F, Alvis R, Deulofeut R, et al. Pulse oxygen saturation levels and arterial oxygen tension values in newborns receiving oxygen therapy in the neonatal intensive care unit: is 85% to 93% an acceptable range? Pediatrics 2008;121:882-9.
25. Greenspan JS, Goldsmith JP. Oxygen therapy in preterm infants: hitting the target. Pediatrics 2006;118:1740-1.
26. Kattwinkel J, Perlman JM, Aziz K, et al. Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics 2010;126:e1400-13.
27. Doreswamy SM, Chakkarapani AA, Murthy P. Oxygen saturation index, a noninvasive tool for monitoring hypoxemic respiratory failure in newborns. Indian pediatr 2016;53:432-3.
28. Sant'Anna GM, Keszler M. Developing a neonatal unit ventilation protocol for the preterm baby. Early hum Dev 2012;88:925-9.
29. Khemani RG, Patel NR, Bart III RD, Newth CJ. Comparison of the pulse oximetric saturation/fraction of inspired oxygen ratio and the PaO2/fraction of inspired oxygen ratio in children. Chest 2009;135:662-8.
30. Khalesi N, Choobdar FA, Khorasani M, Sarvi F, Haghighi Aski B, Khodadost M. Accuracy of oxygen saturation index in determining the severity of respiratory failure among preterm infants with respiratory distress syndrome. J Matern Fetal Neonatal Med 2021;34:2334-9.
31. Alisamir M, Mirkarimi M, Hajatnia S, Zadkarami M. Evaluation of Non-Invasive Oxygen Saturation Index Compared With Oxygenation Index in Pulmonary and Non-Pulmonary Patients Admitted in PICU. Acta Med Iran 2020;58:78-82.
32. Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E. Acute respiratory distress syndrome. JAMA 2012;307:2526-33.
33. Ballard RA, Truog WE, Cnaan A, Martin RJ, Ballard PL, Merrill JD, et al. Inhaled nitric oxide in preterm infants undergoing mechanical ventilation. N Engl J Med 2006;355:343-53.34.
34. Ghaffaripour H, Mirkarimi M, Hassanzad M, Boloursaz M, Mohammadi S. Evaluation of Inflammatory Biomarkers in Iranian Patients with Cystic Fibrosis. Curr Respir Med Rev 2020;16:184-92.
| Files | ||
| Issue | Vol 59, No 6 (2021) | |
| Section | Articles | |
| DOI | https://doi.org/10.18502/acta.v59i6.6896 | |
| Keywords | ||
| Oxygenation index (OI) Oxygen saturation index (OSI) Neonates NICU Arterial blood gas (ABG) Pulse oximetry | ||
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How to Cite
1.
Zadkarami M, Sadat-Mirdamadi N, Hardani A, Mirkarimi M, Alisamir M, Heidari S, Barouti S, Mohammadi S. Evaluation of Oxygenation Index Compared With Oxygen Saturation Index Among Neonates Admitted to the NICU. Acta Med Iran. 2021;59(6):376-382.
