# The Clinical Relevance of Overnight Oximetry in the Diagnosis of Intermittent Desaturations and the Need for Home Oxygen in the Near-Term and Term Infant

## TL;DR

This paper reviews the use of overnight oximetry in diagnosing intermittent desaturations in infants and its relevance for determining the need for home oxygen therapy.

## Contribution

The paper highlights the limitations of overnight oximetry and proposes cerebral NIRS as a more effective diagnostic tool for identifying infants needing long-term oxygen therapy.

## Key findings

- Overnight oximetry lacks established reference ranges, making interpretation problematic.
- Cerebral NIRS may better identify infants requiring long-term oxygen therapy.
- Intermittent desaturations may be linked to later neurodevelopmental impairment.

## Abstract

While intermittent desaturations are a common occurrence in near-term and term infants, these may not be benign events with fluctuations in oxygen saturation associated with later neurodevelopmental impairment. Further, intermittent desaturation events do not necessarily result in intermittent hypoxia (IH). Polysomnography is the gold standard to diagnose intermittent desaturations in infants; however, it remains an expensive, inaccessible test. Therefore, overnight oximetry; an economical and more readily available test, is routinely used in this population. Overnight oximetry employs measurement of peripheral cutaneous arterial oxygen saturation (SpO2) alone to inform clinical management of intermittent desaturations. Management strategies include discharging near-term and term infants on low-flow long-term oxygen therapy (LTOT), typically for upwards of six months. Oxygen saturation targets for neonates have been widely studied. However, interpretation of overnight oximetry is problematic due to a lack of established reference ranges with current approaches still based on limited evidence. This raises questions of the clinical relevancy of overnight oximetry in infants for diagnosing IH and the resultant need for LTOT. Given the association between IH and later neurodevelopmental impairment, concurrent measurement of cerebral tissue oxygen saturation by near-infrared spectroscopy (NIRS) may better identify those near-term and term infants in need of LTOT. Here we review the emerging evidence for the clinical use of cerebral NIRS and the relevance of overnight oximetry in identifying IH in near-term and term newborns and its potential role in identifying those requiring LTOT.