Oxygen saturation trends in the first hour of life in healthy full-term neonates born at moderate altitude

Transition from a parallel circulation in utero to an in-series circulation immediately after birth is partly an oxygen-dependent process. Relative hypoxemia with increasing altitude above sea level exerts a certain degree of stress on oxygen-dependent metabolic processes throughout the body. The present study aimed to determine the reference values for oxygen saturation and the pre-ductal and post-ductal oxygen saturation trends during the first 60 min of life in healthy full-term neonates born at moderate altitude [1500-2500 m] using pulse oximetry. This descriptive study was carried out over a period of three months started from July 2011 in the Neonatology Department of King Abdulaziz Specialist Hospital, Taif, Saudi Arabia. In this observational study, arterial oxygen saturation in the right hand and right foot of each infant was recorded by pulse oximetry immediately after birth and continuously within the first 60 min of life. The respiratory rate, heart rate, and blood pressure were measured at birth and at 1 h after birth. Cord blood gas and haemoglobin levels were also measured. The study was conducted in a hospital situated at an altitude of 1640 m above sea level. Immediately after birth, the mean pre-ductal SpO[2] in the right hand was 68% [51-80%]; in the right foot, the mean post-ductal SpO[2] was 60% [40-77%]. This difference was statistically significant [p < 0.01]; however, it became statistically insignificant at 20 min [4-45 min] and disappeared at 25 min, when the SpO[2] in both limbs equalised at 88% [83-96%]. SpO[2] levels > 94% were reached after 13 min [4-35] min pre-ductally and after 22 min [10-45 min] post-ductally. The mean respiratory rate, heart rate, and mean blood pressure at birth were 56/min, 140/min, and 34 mmHg, respectively; at 60 min, they were 40/min, 123/min, and 47 mmHg, respectively. This study defined normal range of SpO[2] values in healthy full-term neonates born at moderate altitude in the first 60 minutes of life. These are expected to serve as base line data for normal neonates born at similar altitudes. With regard to pre-ductal and post-ductal oxygen saturation levels, cut-off values lower than those used at sea level should be adopted for neonates born at moderate altitudes

Impact of discharge timings of healthy newborns on the rates and etiology of neonatal hospital readmissions

To evaluate the effect of early hospital discharge after initial birth hospitalization on the rate and etiology of hospital readmission during the neonatal period. Cross-sectional analytical study. King Abdulaziz University Hospital, Jeddah, Kingdom of Saudi Arabia, from October 2008 to September 2011. Full-term normal newborns were included in this study, and all infants showing any features that would increase the chances or readmission were excluded. Initial birth hospitalization and readmission in the neonatal period were analyzed. Data was collected from the Discharge Abstract Database. Overall, 12,728 normal newborns were delivered during the study period. Vaginally delivered infants were discharged early [within 48 hours], while those delivered via caesarean section had longer hospital stays [mean length of stay: 1.1 and 2.8 days, respectively]. There were 166 readmissions, wherein the leading cause was neonatal sepsis [37.3%] followed by neonatal jaundice [26.5%]. The readmission rate in early discharged [142 out of 9927] was significantly higher [p = 0.017] as compared to newborns who were discharged late after birth [24 out of 2801]. Etiology of readmissions was not affected by discharge timings. Hospital discharge of neonates within 48 hours after delivery is counterproductive and significantly increases the risk for hospital readmission during the neonatal period. The pre-dominance of sepsis related cases observed here indicates the need to explore its causes and determine an optimal prevention and management strategy