Abstract
Now that pulse oximetry is used widely to screen for critical congenital heart disease, it is time to consider whether this screening method is applicable to those who live at high altitudes. Consideration of basic physical principles and reports from the literature indicate that not only is the 95 % cutoff point for arterial oxygen saturation incorrect at high altitudes, but the lower saturations are accompanied by greater variability and therefore there is the possibility of a greater percentage of false-positive screening tests at high altitudes. Because of ethnic differences in response to high altitudes, normative data will have to be collected separately in different countries and perhaps for different ethnic groups.
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References
Kemper AR, Mahle WT, Martin GR, Cooley WC, Kumar P, Morrow WR, Kelm K, Pearson GD, Glidewell J, Grosse SD, Howell RR (2011) Strategies for implementing screening for critical congenital heart disease. Pediatrics 128:e1259–1267
Thangaratinam S, Brown K, Zamora J, Khan KS, Ewer AK (2012) Pulse oximetry screening for critical congenital heart defects in asymptomatic newborn babies: a systematic review and meta-analysis. Lancet 379:2459–2464
Cohen JE, Small C (1998) Hypsographic demography: the distribution of human population by altitude. Proc Natl Acad Sci USA 95:14009–14014
World Population. Wikipedia
Rahn H, Fenn WO (1955) A graphical analysis of the respiratory gas exchange. American Physiological Society, Washington, D.C.
Nelson NM, Prod’hom LS, Cherry RB, Lipsitz PJ, Smith CA (1963) Pulmonary function in the newborn infant: the alveolar-arterial oxygen gradient. J Appl Physiol 18:534–538
Bakr AF, Habib HS (2005) Normal values of pulse oximetry in newborns at high altitude. J Trop Pediatr 51:170–173
Balasubramanian S, Suresh N, Raeshmi R, Kaarthigeyan K (2008) Comparison of oxygen saturation levels by pulse oximetry in healthy children aged 1 month to 5 years residing at an altitude of 1500 m and at sea level. Ann Trop Paediatr 28:267–273
Banchero N, Sime F, Peñaloza D, Cruz J, Gamboa REM (1966) Pulmonary pressure, cardiac output, and arterial oxygen saturation during exercise at high altitude and at sea level. Circulation 33:249–262
Basnet S, Adhikari RK, Gurung CK (2006) Hypoxemia in children with pneumonia and its clinical predictors. Ind J Ped 73:777–781
Beall CM (2006) Andean, Tibetan, and Ethiopian patterns of adaptation to high-altitude hypoxia. Integr Comp Biol 46:18–24
Beebe SA, Heery LB, Magarian S, Culberson J (1994) Pulse oximetry at moderate altitude. Healthy children and children with upper respiratory infection. Clin Pediatr 33:329–332
Bloch KE, Latshang TD, Turk AJ, Hess T, Hefti U, Merz TM, Bosch MM, Barthelmes D, Hefti JP, Maggiorini M, Schoch OD (2010) Nocturnal periodic breathing during acclimatization at very high altitude at Mount Muztagh Ata (7546 m). Am J Respir Crit Care Med 182:562–568
Bruce N, Weber M, Arana B, Diaz A, Jenny A, Thompson L, McCracken J, Dherani M, Juarez D, Ordonez S, Klein R, Smith KR (2007) Pneumonia case-finding in the RESPIRE Guatemala indoor air pollution trial: standardizing methods for resource-poor settings. Bull World Health Organ 85:535–544
Duke T, Blaschke AJ, Sialis S, Bonkowsky JL (2002) Hypoxaemia in acute respiratory and non-respiratory illnesses in neonates and children in a developing country. Arch Dis Child 86:108–112
Dyke T, Lewis D, Heegaard W, Manary M, Flew S, Rudeen K (1995) Predicting hypoxia in children with acute lower respiratory infection: a study in the highlands of Papua New Guinea. J Trop Pediatr 41:196–201
Gamponia MJ, Babaali H, Yugar F, Gilman RH (1998) Reference values for pulse oximetry at high altitude. Arch Dis Child 78:461–465
Goldberg S, Buhbut E, Mimouni FB, Joseph L, Picard E (2012) Effect of moderate elevation above sea level on blood oxygen saturation in healthy young adults. Respiration 84:207–211
Gonzales GF, Salirrosas A (2005) Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m). Reprod Biol Endocrinol 3:46
Habib HS (2013) Oxygen saturation trends in the first hour of life in healthy full-term neonates born at moderate altitude. Pak J Med Sci 29:903–906
Huicho L, Pawson IG, Leon-Velarde F, Rivera-Chira M, Pacheco A, Muro M, Silva J (2001) Oxygen saturation and heart rate in healthy school children and adolescents living at high altitude. Am J Hum Biol 13:761–770
Kidd LR, Duncan C, Mason NP (2013) Variations in pulse oximetry at high altitude. High Alt Med Biol 14:87
Levesque BM, Pollack P, Griffin BE, Nielsen HC (2000) Pulse oximetry: What’s normal in the newborn nursery? Pediatr Pulmonol 30:406–412
Lozano JM, Duque OR, Buitrago T, Behaine S (1992) Pulse oximetry reference values at high altitude. Arch Dis Child 67:299–301
Luks AM, Swenson ER (2011) Pulse oximetry at high altitude. High Alt Med Biol 12:109–119
Madico G, Gilman RH, Jabra A, Rojas L, Hernandez H, Fukuda J, Bern C, Steinhoff M (1995) The role of pulse oximetry. Its use as an indicator of severe respiratory disease in Peruvian children living at sea level. Respiratory Group in Peru. Arch Pediatr Adolesc Med 149:1259–1263
Muhe L, Weber M (2001) Oxygen delivery to children with hypoxaemia in small hospitals in developing countries. Int J Tuberc Lung Dis 5:527–532
Muza R, Fulco CS, Cymerman A (2004) Altitude acclimatization guide. USARIEM Technical Note TN04-05. US Army Research Institute of Environmental Medicine, Natick, pp 1–14
Napoli AM, Milzman DP, Damergis JA, Machan J (2009) Physiologic affects of altitude on recreational climbers. Am J Emerg Med 27:1081–1084
Nicholas R, Yaron M, Reeves J (1993) Oxygen saturation in children living at moderate altitude. J Am Board Fam Prac 6:452–456
Niermeyer S, Shaffer EM, Thilo E, Corbin C, Moore LG (1993) Arterial oxygenation and pulmonary arterial pressure in healthy neonates and infants at high altitude. J Pediatr 123:767–772
Niermeyer S, Yang P, Shanmina Drolkar, Zhuang J, Moore LG (1995) Arterial oxygen saturation in Tibetan and Han infants born in Lhasa, Tibet. N Engl J Med 333:1248–1252
O’Brien LM, Stebbens VA, Poets CF, Heycock EG, Southall DP (2000) Oxygen saturation during the first 24 h of life. Arch Dis Child Fetal Neonatal Ed 83:F35–38
Onyango FE, Steinhoff MC, Wafula EM, Wariua S, Musia J, Kitonyi J (1993) Hypoxaemia in young Kenyan children with acute lower respiratory infection. Br Med J 306:612–615
Ravert P, Detwiler TL, Dickinson JK (2011) Mean oxygen saturation in well neonates at altitudes between 4498 and 8150 ft. Adv Neonatal Care 11:412–417
Reuland DS, Steinhoff MC, Gilman RH, Bara M, Olivares EG, Jabra A, Finkelstein D (1991) Prevalence and prediction of hypoxemia in children with respiratory infections in the Peruvian Andes. J Pediatr 119:900–906
Sakamoto S (2006) Reference values of arterial oxygen saturation and heart rate at the ALMA site. ALMA Memo No 549:1–16
Salas AA (2008) Pulse oximetry values in healthy term newborns at high altitude. Ann Trop Paediatr 28:275–278
Saleu G, Lupiwa S, Javati A, Namuigi P, Lehmann D (1999) Arterial oxygen saturation in healthy young infants in the highlands of Papua New Guinea. Papua New Guinea Med J 42:90–93
Schult S, Canelo-Aybar C (2011) Oxygen saturation in healthy children aged 5–16 years residing in Huayllay, Peru at 4340 m. High Alt Med Biol 12:89–92
Shrestha S, Shrestha S, Shrestha L, Bhandary N (2012) Oxygen saturation of hemoglobin in healthy children of 2–14 years at high altitude in Nepal. Kathmandu Univ Med J 10:40–43
Subhi R, Smith K, Duke T (2009) When should oxygen be given to children at high altitude? A systematic review to define altitude-specific hypoxaemia. Arch Dis Child 94:6–10
Thilo EH, Park-Moore B, Berman ER, Carson BS (1991) Oxygen saturation by pulse oximetry in healthy infants at an altitude of 1610 m (5280 ft). What is normal? Am J Dis Child 145:1137–1140
Weber MW, Usen S, Palmer A, Jaffar S, Mulholland EK (1997) Predictors of hypoxaemia in hospital admissions with acute lower respiratory tract infection in a developing country. Arch Dis Child 76:310–314
Weitz CA, Garruto RM (2007) A comparative analysis of arterial oxygen saturation among Tibetans and Han born and raised at high altitude. High Alt Med Biol 8:13–26
de-Wahl Granelli A, Wennergren M, Sandberg K, Mellander M, Bejlum C, Inganas L, Eriksson M, Segerdahl N, Agren A, Ekman-Joelsson BM, Sunnegardh J, Verdicchio M, Ostman-Smith I (2009) Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39,821 newborns. Br Med J 338:a3037
Cole TJ, Green PJ (1992) Smoothing reference centile curves: the LMS method and penalized likelihood. Stat Med 11:1305–1319
Cole TJ, Stanojevic S, Stocks J, Coates AL, Hankinson JL, Wade AM (2009) Age- and size-related reference ranges: a case study of spirometry through childhood and adulthood. Stat Med 28:880–898
Indrayan A (2014) Demystifying LMS and BCPE methods of centile estimation for growth and other health parameters. Ind Pediatr 51:37–43
Wright J, Kohn M, Niermeyer S, Rausch CM (2014) Feasibility of critical congenital heart disease newborn screening at moderate altitude. Pediatrics 133:e561–569
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Hoffman, J.I.E. Is Pulse Oximetry Useful for Screening Neonates for Critical Congenital Heart Disease at High Altitudes?. Pediatr Cardiol 37, 812–817 (2016). https://doi.org/10.1007/s00246-016-1371-1
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DOI: https://doi.org/10.1007/s00246-016-1371-1