Racial discrepancy in pulse oximeter accuracy in preterm infants

OBJECTIVE: Pulse oximetry is commonly used in Neonatology, however recent adult data suggest racial disparity in accuracy, with overestimation of oxygen saturation for Black patients. STUDY DESIGN: Black and White infants <32 weeks gestation underwent simultaneous arterial blood gas and pulse oximetry measurement. Error by race was examined using mean bias, A(rms), Bland–Altman, and linear/non-linear analysis. RESULTS: A total of 294 infants (124 Black, 170 White) were identified with mean GA of 25.8 ± 2.1 weeks and mean BW of 845 ± 265 grams, yielding 4387 SaO(2)–SpO(2) datapoints. SpO(2) overestimation, measured by mean bias, was 2.4-fold greater for Black infants and resulted in greater occult hypoxemia (SpO(2) > 90% when SaO(2) < 85%; 9.2% vs. 7.7% of samples). Sensitivity and specificity for detection of true hypoxemia were similar between groups (39 vs. 38%; 81 vs. 78%). CONCLUSION: There is a modest but consistent difference in SpO(2) error between Black and White infants, with increased incidence of occult hypoxemia in Black infants.