Oximetry devices emitting light at 5 wavelengths may reduce interference from bilirubin and thus improve regional tissue oxygen saturation (rSO2) readings in infants and children with hyperbilirubinemia.

This could prove helpful when treating children with Alagille syndrome (ALGS), whose serum bilirubin values are up to 30 times normal levels.

“The results of this prospective study in children undergoing LDLT [living donor liver transplantation] show that medical conditions inducing hyperbilirubinemia significantly reduce rSO2 values measured by the INVOS 5100 C that only uses 2 wavelengths (of which one corresponds to the absorption peak of conjugated bilirubin) as compared to the ForeSight Elite monitor using 5 wavelengths,” the authors wrote in Pediatric Anesthesia.

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The results showed that rSO2 readings were different in the 2 devices at all time points. The analyses of cerebral and somatic rSO2 readings between the 2 devices had a mean absolute bias of 21.73% and a 95% limits of agreement of 19.52%.

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Moreover, the application of a linear mixed effects model to the data revealed a statistically significant difference in cerebral rSO2 readings in terms of time, device, and total bilirubin concentrations. Similarly, it showed a statistically significant difference in somatic rSO2 readings regarding the device and total bilirubin concentrations.

In contrast, hemoglobin values, pulse oximetry oxygen saturation, and arterial partial pressure of CO2 did not interfere with cerebral or somatic rSO2 readings.

The study enrolled 33 patients (median age, 27 months) undergoing living donor liver transplantation. Two patients were diagnosed with ALGS, whereas most (66.7%) had biliary atresia. The authors measured cerebral and somatic rSO2 at baseline, at the beginning of the dissection phase, at the beginning of the anhepatic phase, at the reperfusion phase, and at skin closure.


Magasich-Airola NP, Momeni M, Sanchez Torres C, et al. Regional oxygen saturation measured by two different oximetry monitors in infants and children undergoing living donor liver transplantation with bilirubin measurements: a prospective observational study. Pediatr Anesth. Published online November 5, 2022. doi:https://doi.org/10.1111/pan.14597