HbCo in mothers and newborns

Accuracy of fetal pulse oximetry and pitfalls in measurements

Pulse oximetry is a technique for estimating arterial oxygen saturation continuously and non-invasively. Reflectance pulse oximetry might become useful for monitoring the fetus during labour but it is much more susceptible to all kinds of physiological variations than the well-established transmission pulse oximetry for neonatal or adult monitoring. This review focuses on the accuracy of reflectance pulse oximetry. Results of human, animal, in vitro and theoretical models indicate that factors such as; blood volume fraction differences, haematocrit, and blood flow differences are major sources for inaccurate pulse oximetry readings in the fetal arterial oxygen saturation range of 10-80%. These factors cannot be overcome by systems using two wavelengths sensors with the 660/890 or 940 nm combination. Reported precision values (S.D. of difference between pulse oximeter and blood sample saturation) range between 2.5 and 12.9% for various 660 nm sensors. Most sensors were tested only once with a limited number of animals. A new 735/890 nm sensor (Nellcor Puritan Bennett) demonstrates a promising accuracy (precision around 5%) in two studies. Various other sensors have also been developed, but are not or scarcely evaluated. Without thorough establishment of the reliability of this technique, clinical fetal oxygen saturation data are still of limited value.

Notes on the apparent discordance of pulse oximetry and multi-wavelength haemoglobin photometry

Multi-wavelength photometers, blood gas analysers and pulse oximeters are widely used to measure various oxygen-related quantities. The definitions of these quantities are not always correct. This paper gives insight in the various definitions for oxygen quantities. Furthermore, the possible influences of dyshaemoglobins and fetal haemoglobin on the accuracy of pulse oximetry are discussed. As pulse oximeters are constructed for the determination of arterial oxygen saturation, they should be validated with sample oxygen saturation values and not with the oxyhaemoglobin fraction. The influence of carboxyhaemoglobin is insubstantial over an oxygen saturation range of 0% to 100%. Through the presence of methaemoglobin, pulse oximetry will give an underestimation above 70% and an overestimation below 70% oxygen saturation. The influence of fetal haemoglobin is insignificant in the neonatal use of pulse oximetry, in the range of 75% to 100% arterial oxygen saturation. However, a pulse oximeter underestimates the arterial oxygen saturation at the 25% level with 5%, if the pulse oximeter has been calibrated in human adults. Such a low level of arterial oxygen saturation can be present in the fetus during labor.

Glutathione and glutathione-metabolizing enzymes in the erythrocytes of healthy children and in children with insulin-dependent diabetes mellitus, juvenile rheumatoid arthritis, coeliac disease and acute lymphoblastic leukaemia

Oxidative biotransformation of xenobiotics and endogenous substances involves glutathione in reduced form as an integral component through two mechanisms: glutathione peroxidase catalysing the reduction of hydrogen peroxide and organic hydroperoxides, and glutathione-S-transferases catalysing the conjugation of oxygenated derivatives with glutathione. We studied glutathione and glutathione-related enzyme activities in haemolysed venous blood samples from 49 healthy children and from 11 children with diabetes mellitus, 10 children with rheumatoid arthritis, seven children with active coeliac disease, and seven children with acute lymphoblastic leukaemia. Among the healthy children glutathione content and the activities of glutathione reductase, glutathione peroxidase, and glutathione-S-transferase were unrelated to sex; age-dependent differences were also minor. The patients with diabetes mellitus had decreased activity of glutathione reductase. The patients with acute lymphoblastic leukaemia had increased activity of both glutathione peroxidase and glutathione-S-transferase, possibly reflecting an adaptive response to free-radicals. The patients with active coeliac disease had control levels of all measured parameters of glutathione-related reactions indicating, since we earlier found decreased activities of glutathione peroxidase in intestinal mucosa of celiacs, that blood may not always reflect tissue-specific changes.