History of Pulse Oximetry in Neonatal Medicine

Although pulse oximetry in neonatal medicine was introduced fewer than 25 years ago, today it is the principal form of oxygen monitoring around the world in nearly all clinical situations that require measurement of oxygen in neonates. It has become, in fact, the fifth vital sign in neonatal medicine. For the near future, it holds center stage as the primary form of oxygen monitoring for a large international commitment to determine, after more than 50 years of mistakes, mistrials, and misunderstandings, the appropriate level of oxygen supply and blood oxygenation in preterm infants. Hopefully, these studies and the unique advantages of pulse oximetry will help to eliminate, or at least diminish, the adverse effects of too much oxygen, such as retinopathy of prematurity (ROP), without increasing the incidence of complications of hypoxia, such as patent ductus arteriosus (PDA) and pulmonary hypertension. The purpose of this review is to look back at how oximetry began, how “pulse” oximetry was developed, and how this new technology has revolutionized oxygen monitoring in neonatal medicine. Oximetry, or the use of light to measure the amount of oxygen carried in the blood, began in about 1874, when Karl von Vierordt attempted to measure blood saturation in the human hand. Quantitative oximetry began with Krogh in Copenhagen just after World War I in 1918. In the 1930s, Millikan and Wood developed the two-wavelength ear oximeter that later was modified in 1935 by Matthes into the first oxygen saturation meter using red and green filters (personal communication, W. Clifford, 2004). Squire developed an instrument for measuring the quantity of blood and its degree of oxygenation in the web of the hand in 1940, and Goldie developed a device for continuous indication of oxygen saturation in circulating blood in adults in 1942. (1)(2)(3) …