An unusual case of SpO2-PaO2 discrepancy in an intensive care neonate illustrating an important pitfall in routine pulse oxygen monitoring
Abstract
Background: In the last decades, pulse oximetry became an essential part of routine monitoring, ubiquitously present from low to high intensive care units. In most cases, pulse oxygen saturation levels (SpO2) are reliable and reflect the simultaneous partial pressure of oxygen in the blood (PaO2). Nevertheless, specific morbidity, of which methemoglobinemia might be the most well-known, can interfere with this correlation. Clinicians should cautiously interpret SpO2 levels in such cases. Methods: A case report describing a rare SpO2-PaO2 discrepancy and literature review concerning similar cases. Results: Progressive hydrops foetalis, caused by Rhesus antagonism and requiring multiple blood transfusions intrauterine, occurred in a premature born (GA 30+2/7w) female infant (G4P4A0). She was hospitalised at the neonatal intensive care unit. Endotracheal intubation, fluid resuscitation and hemodynamic support was necessary. Hemolytic anemia, trombopenia and early-onset hyperbilirubinemia was present. Blood transfusions and intensive phototherapy were given. Progressive cholestasis developed. A severe picture of bronze baby syndrome (BBS), a skin discoloration typically caused by brown photoproducts of accumulated porphyrines (as present in significant cholestasis), followed in the first week of life. During mechanical ventilation, vital parameters were intensively monitored and frequent arterial blood gas analysis took place. At the age of 1 week, prolonged episodes of low SpO2…
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