European Journal of Pediatrics

, Volume 175, Issue 2, pp 171–179 | Cite as

Validity of non-invasive point-of-care hemoglobin estimation in healthy and sick children—a method comparison study

  • Aditya Bhat
  • Amit UpadhyayEmail author
  • Vijay Jaiswal
  • Deepak Chawla
  • Dharamveer Singh
  • Mithilesh Kumar
  • C. P. Yadav
Original Article


This study was conducted at a tertiary care center in northern India to evaluate the validity of non-invasive transcutaneous hemoglobin estimation in healthy and sick children in comparison to hemoglobin estimation by traditional lab method. A method comparison study was conducted including 150 subjects. Enrolled patients included 80 neonates with average age of 3.9 ± 2.1 days, and 70 children with average age of 5.8 ± 2 years. Each population (newborn and children) comprised of almost equal numbers of healthy and critically ill patients with shock. Hemoglobin (Hb) was estimated on enrolment by transcutaneous spectrophotometry (SpHb) and traditional automated lab analyzer (Hb-Lab). Difference between Hb levels by the two methods (called bias) was measured and analyzed using Bland-Altman method. Out of 148 data pairs analyzed, bias between SpHb and Hb-Lab was −1.52 ± 1.91 g/dl (mean ± SD). SpHb showed excellent positive correlation with Hb-Lab (r = 0.94 (p < 0.001)) and good visual agreement on Bland-Altman plots. Bias was higher in sick subjects with shock as compared to healthy ones in both neonatal and pediatric population (−2.31 ± 2.21 g/dl versus −0.77 ± 1.2 g/dl, respectively).

Conclusions: SpHb showed good accuracy and correlated well with lab estimated Hb levels in healthy children. However, in children with impaired peripheral perfusion, its diagnostic accuracy was inadequate to justify routine use for quantification of severity of anemia and making transfusion decisions solely on non-invasive estimation of hemoglobin.

What is Known:

Non-invasive hemoglobin estimation is a relatively new and novel method which has given mixed results regarding its potential efficacy in adults.

There is limited data regarding usefulness and accuracy of non-invasive Hb estimation by SpHb in sick neonates and children.

What is New:

Non-invasive Hb estimation by SpHb monitor is reasonably accurate in healthy neonates and children.

It can be used in critically ill children and neonates, but in conjunction with lab confirmation of Hb values.


SpHb Non-invasive hemoglobin Point-of-care hemoglobin Shock Anemia 



hemoglobin measured using automated lab analyzer


neonatal intensive care unit


pediatric intensive care unit


hemoglobin measured using non-invasive transcutaneous pulse co-oximeter


standard deviation


Compliance with Ethical Standards


No funds were granted for this study

Conflict of Interest

The authors declare that they have no competing interests.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Prior to conduct of study approval was taken from Institutional Ethical Review Board.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Authors’ contributions

AU conceptualized, supervised, provided the overall intellectual content and will be the guarantor of this study. AB collected the data, reviewed the literature, and drafted the manuscript. DC and CPY aided in data analysis. VJ, DVS, and MK aided in critical appraisal and research.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Aditya Bhat
    • 1
  • Amit Upadhyay
    • 1
    Email author
  • Vijay Jaiswal
    • 1
  • Deepak Chawla
    • 2
  • Dharamveer Singh
    • 1
  • Mithilesh Kumar
    • 1
  • C. P. Yadav
    • 3
  1. 1.Department of PaediatricsLLRM Medical CollegeUttarIndia
  2. 2.Department of PaediatricsGovernment Medical CollegeChandigarhIndia
  3. 3.Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia

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