Pulse oximetry in pediatric care: Balancing advantages and limitations

Table 3 Clinical indications of pulse oximetry in neonates, infants, and children

Clinical application	Description
Neonatal indications
Fetal and neonatal care	Pulse oximetry can continuously monitor oxygen saturation during delivery and in neonates with respiratory distress syndrome, congenital heart defects, or other respiratory conditions
Newborn screening for CCHD	Pulse oximetry screening detects CCHD in newborns by comparing SpO2 readings between the upper and lower extremities, indicating the presence of heart defects
RDS	Pulse oximetry assesses oxygenation and monitors respiratory status in preterm infants with RDS, guiding oxygen therapy and evaluating response to treatment
BPD	Pulse oximetry monitors oxygenation and respiratory status in infants with BPD, guiding oxygen therapy, detecting complications, and assessing response to interventions
Apnea of prematurity	Pulse oximetry detects oxygen desaturation events associated with apnea in premature infants, allowing for prompt intervention and monitoring of respiratory status
PPHN	Pulse oximetry assesses oxygenation and monitors response to treatment in infants with PPHN, guiding oxygen therapy and evaluating the effectiveness of interventions
Neonatal methemoglobinemia	Pulse oximetry may underestimate O2 saturation in neonatal methemoglobinemia, prompting further investigation and monitoring of response to treatment
Postoperative care	Pulse oximetry monitors O2 saturation levels in neonates after surgery, facilitating early detection of respiratory compromise & guiding interventions for optimal recovery
Infancy and childhood indications
Children with respiratory illnesses	Pulse oximetry is essential for managing respiratory illnesses in children. It aids in assessing oxygen saturation levels and the severity of the condition, monitoring oxygen therapy effectiveness, tracking treatment response, and guiding clinical decisions. It provides valuable insights into conditions like pneumonia, bronchiolitis, and asthma exacerbations
Assessment of circulatory status	Pulse oximetry is significant in evaluating circulatory status in children. It allows for the early detection of circulatory compromise and guides interventions to restore perfusion and prevent organ dysfunction. It also provides real-time feedback on treatment effectiveness, particularly in cases of shock or hypovolemia
Monitoring during anesthesia and sedation	Pulse oximetry is crucial for monitoring children during anesthesia and sedation. It enables continuous assessment of SpO2 levels and pulse rate. It aids in the early detection of respiratory depression, airway obstruction, and hypoxemia, ensuring patient safety during procedures requiring anesthesia or sedation
Management of sleep disorders	Pulse oximetry is instrumental in managing childhood sleep disorders such as OSA or central sleep apnea. It facilitates screening, assesses severity, monitors treatment effectiveness, and detects complications. It also enables home monitoring, leading to early treatment failure or disease progression detection
Evaluation of trauma and critical care	Pulse oximetry assists in the rapid assessment of oxygenation status in children with trauma or critical illness, aiding in the early detection of hypoxemia and respiratory compromise. It provides continuous monitoring during critical care interventions and facilitates timely escalation of care
Home monitoring	Pulse oximetry is valuable for monitoring various childhood disorders at home, including respiratory conditions, congenital heart diseases, neurological disorders, and neonatal complications. It enables early detection of abnormalities, prompts medical attention, and enhances accessibility to healthcare services when integrated with telemedicine technologies

BPD: Bronchopulmonary dysplasia; CCHD: Critical congenital heart disease; OSA: Obstructive sleep apnea; PPHN: Persistent pulmonary hypertension of the newborn; RDS: Respiratory distress syndrome; SpO₂: Oxygen saturation.