NeoNotes
Journal Club
Andrew B. Kairalla MD, Editor
Junaid M. Khan MD, Guest Editor
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Now
Objective:
Use of video recordings of newborn infants to determine: (1) if
clinicians agreed whether infants were pink; and (2) the pulse
oximeter oxygen saturation (SpO2) at which infants first
looked pink.
Methods:
Selected clips from video recordings of infants taken immediately
after delivery were shown to medical and nursing staff. The infants
received varying degrees of resuscitation (including none) and were
monitored with pulse oximetry. The oximeter readings were obscured to
observers but known to the investigators. A timer was visible and the
sound was inaudible. The observers were asked to indicate whether
each infant was pink at the beginning, became pink during the clip,
or was never pink. If adjudged to turn pink during the clip,
observers recorded the time this occurred and the corresponding SpO2
was determined.
Results: 27 clinicians
assessed videos of 20 infants (mean (SD) gestation 31(4) weeks). One
infant (5%) was perceived to be pink by all observers. The number of
clinicians who thought each of the remaining 19 infants were never
pink varied from 1 (4%) to 22 (81%). Observers determined the 10
infants with a maximum SpO2 
95%
never pink on 17% (46/270) of occasions. The SpO2 at which
individual infants were perceived to turn pink varied from 10% to
100%.
Conclusion:
Among clinicians observing the same videos there was disagreement
about whether newborn infants looked pink with wide variation in the
SpO2 when they were considered to become pink.
Comments: It is very interesting study. And it is quiet true that clinical judgment can vary from physician to physician and physician to a lab test or Spo2. In my opinion we should correlate both together and confirm it by other means also. We should be more careful before reaching to any conclusion. JMK
Editor’s Comment: A baby’s color depends on a number of
factors including oxygen saturation, hemoglobin concentration, skin perfusion,
degree of R>L shunting, skin pigmentation, etc. There is also much
inter-observer variability. When possible, we should base decisions on oxygen
need on pulse oximetry rather than color. ABK
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