The precision and accuracy of Nellcor and Masimo oximeters at low oxygen saturations (70%) in newborn lambs

Arch Dis Child Fetal Neonatal Ed. 2014 Jul;99(4):F278-81. doi: 10.1136/archdischild-2013-305091. Epub 2014 Mar 4.


Background: Administration of oxygen in the delivery room is informed by oxygen saturation (SpO₂). An oxygen saturation range of 60%-70% is the threshold for administering oxygen in the first minutes after birth. The accuracy of newer generation oximeters to measure SpO₂ has not been compared against the 'gold standard', direct arterial blood oxygen saturation (SaO₂) when SaO₂ is low. The aim of this study was to determine the accuracy and precision of Nellcor and Masimo oximeters to measure SpO₂ when SaO₂ <70%.

Method: Prospective observational study in ventilated anaesthetised newborn lambs with an indwelling carotid artery catheter. Ventilation was adjusted to achieve hypoxaemia. Nellcor (Oxi-Max 600 with Max-N sensor) and Masimo (Rad 4 with low noise optical probe (LNOP) sensor) sensors were applied to the right forelimb (preductal). An arterial blood sample was collected at 1-5 min intervals when the animal was hypoxic. The displayed SpO₂ was recorded. We used Bland-Altman analysis to determine precision and accuracy of each oximeter when SaO₂ <70%.

Results: 17 lambs were studied, 165 measurements were obtained, 123 were SaO₂ <70%. The mean difference (±1.96 SD) Nellcor SpO₂-SaO₂ when SaO₂ <70% was 17% (-12% to 46%). The mean difference (±1.96 SD) Masimo SpO₂-SaO₂ when SaO2 <70% was 13% (-19% to 45%).

Conclusions: At SaO₂<70%, both monitors overestimated oxygen saturation (SpO₂) compared with the gold standard. Both oximeters were equally inaccurate when SaO₂ was low.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Animals, Newborn
  • Disease Models, Animal
  • Hypoxia / blood
  • Hypoxia / diagnosis*
  • Hypoxia / therapy
  • Oximetry / instrumentation*
  • Oximetry / methods
  • Oximetry / standards
  • Oxygen / blood*
  • Oxygen Inhalation Therapy
  • Reproducibility of Results
  • Sheep, Domestic


  • Oxygen