Evaluation of Pulse Oximetry Alarm Fatigue and the Impact of SpO ₂ Thresholds on Clinical Workflow: A Prospective Observational Study in a Kenyan Neonatal Unit

Introduction: Effective pulse oximetry monitoring in a newborn unit requires clinician action. However, if thresholds are not adapted to each neonate, frequent alarms cause alarm fatigue, which impacts the quality of patient monitoring, staff workload and clinical workflow. Methods: We conducted an observational study from October 2021 to December 2022 in a Kenyan newborn unit which enrolled neonates through convenience sampling. Data were analysed in R using default thresholds of 85% to 96% for SpO 2 and 90 to 200 bpm for PR. Results: Among the 49 neonates enrolled, median hourly alarms per patient were 12 visual and 9 audible. Half of SpO 2 values were outside the set thresholds. The hourly alarm density per neonate was 4 SpO 2 alarms and 1 PR alarm. Conclusions: The selected SpO 2 alarm thresholds resulted in a high alarm burden which necessitates neonate-specific thresholds and delays. This improves monitoring specificity and sensitivity, enhancing neonatal care and effectiveness in resource-limited settings.