Investigation of fontanelle photoplethysmographs and oxygen saturations in intensive care neonates and infants utilising miniature photometric sensors

摘要

In children and newborn babies on intensive care, information regarding blood oxygen saturation (SpO2) is determined non-invasively by a device called a pulse oximeter. Sensors are usually placed on a hand or foot where their operation relies on the presence of pulsatile arterial blood. Light shines at two or more wavelengths (usually red and infrared) into the tissue where the pulsatile blood modulates, absorbs and scatters the different wavelengths of light in varying amounts and is detected by a photo-detector as a photoplethysmograph (PPG). The spectral information received is then processed electronically and digitally to determine the amount of haemoglobin present. In the sickest of children blood supply can become compromised to these sensor locations and the pulsatile component of the blood may diminish and pulse oximeter readings may become unreliable, especially at times when accurate blood oxygen information would be vital. Currently the alternative is to take blood from an arterial line and run a relatively lengthy analysis (pulse oximeters are near-instantaneous in their operation) that may be unnecessary if the pulse oximeter could be relied upon at these critical moments. In the smallest of babies invasive sampling of blood becomes even more of an issue as any blood loss could lead to hypovolaemia and introduce extra sites of infection plus it causes a lot of stress to the neonate. Since central blood flow may be preferentially preserved, the anterior fontanelle was investigated as an alternative monitoring site. Custom reflectance fontanelle and reference PPG sensors have been designed and built to investigate the fontanelle in those children at risk of peripheral supply compromise. Dedicated instrumentation and software has also been successfully developed for the control of the sensor electronics and the data-logging of PPG signals for retrospective analysis. Sixteen neonates were recruited for fontanelle monitoring; all were ASA 1 – 3 (ASA ranges from 1 to 5 where 1 is the least sick and 5 is the most critically ill). As part of the approved protocol the delivered oxygen to the patients was artificially altered to look for corresponding changes in PPG signal amplitudes. Amplitude results reveal strong correlations (R > 0.5) between the reference sensor (placed on the foot) and the fontanelle sensor. This suggests that the fontanelle sensor is sensitive to changes in amplitude when oxygen in the blood alters. Correlation of the health of the child, using the ASA score, and the difference in amplitudes of PPGs between the sensors reveals that the fontanelle sensor does detect increasing fontanelle PPG amplitudes when compared to the PPGs from the reference sensor the sicker the child is, confirming that pulsatile flow is being preferentially preserved at the fontanelle in those children who are the most at risk from peripheral supply compromise. SpO2 estimation at the fontanelle reveals a mean difference of 2.2 % to the SpO2 as read by the commercial device and a 1.7 % difference to the blood gas results. These results confirm that the anterior fontanelle may be used as an alternative location for SpO2 measurement in those who are at most risk of peripheral supply compromise.