Enhanced Neonatal Pulse Oximetry Sounds for the First Minutes of Life: A Laboratory Trial

Abstract

Objective

Auditory enhancements to the pulse oximetry tone may help clinicians detect deviations from target ranges for oxygen saturation (SpO₂) and heart rate (HR).

Background

Clinical guidelines recommend target ranges for SpO₂ and HR during neonatal resuscitation in the first 10 minutes after birth. The pulse oximeter currently maps HR to tone rate, and SpO₂ to tone pitch. However, deviations from target ranges for SpO₂ and HR are not easy to detect.

Method

Forty-one participants were presented with 30-second simulated scenarios of an infant’s SpO₂ and HR levels in the first minutes after birth. Tremolo marked distinct HR ranges and formants marked distinct SpO₂ ranges. Participants were randomly allocated to conditions: (a) No Enhancement control, (b) Enhanced HR Only, (c) Enhanced SpO₂ Only, and (d) Enhanced Both.

Results

Participants in the Enhanced HR Only and Enhanced SpO₂ Only conditions identified HR and SpO₂ ranges, respectively, more accurately than participants in the No Enhancement condition, ps < 0.001. In the Enhanced Both condition, the tremolo enhancement of HR did not affect participants’ ability to identify SpO₂ range, but the formants enhancement of SpO₂ may have attenuated participants’ ability to identify tremolo-enhanced HR range.

Conclusion

Tremolo and formant enhancements improve range identification for HR and SpO₂, respectively, and could improve clinicians’ ability to identify SpO₂ and HR ranges in the first minutes after birth.

Application

Enhancements to the pulse oximeter tone to indicate clinically important ranges could improve the management of oxygen delivery to the neonate during resuscitation in the first 10 minutes after birth.

Keywords

auditory displays sonification neonatal resuscitation healthcare

Get full access to this article

View all access options for this article.

References

AIHW . (2019). Australia’s mothers and babies. Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/baby-outcomes/active-resuscitation-method

Anderson

J. E.

Sanderson

(2009). Sonification design for complex work domains: dimensions and distractors. Journal of Experimental Psychology: Applied, 15(3), 183–198. https://doi.org/10.1037/a0016329

Australian Resuscitation Council . (2016). ANZCOR guideline 13.3 - assessment of the newborn infant. https://resus.org.au/guidelines/

Australian Resuscitation Council (2021). ANZCOR guideline 13.3 - assessment of the newborn infant. https://www.neoresus.org.au/learning-resources/key-concepts/summary/

Aziz

Lee

C. H. C.

Escobedo

M. B.

Hoover

A. V.

Kamath-Rayne

B. D.

Kapadia

V. S.

Magid

D. J.

Niermeyer

Schmolzer

G. M.

Szyld

Weiner

G. M.

Wyckoff

M. H.

Yamada

N. K.

Zaichkin

(2021). Part 5: Neonatal resuscitation 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Pediatrics, 147(Suppl 1), S160–S190. https://doi.org/10.1542/peds.2020-038505E

Ban

J. E.

(2017). Neonatal arrhythmias: diagnosis, treatment, and clinical outcome. Korean Journal of Pediatrics, 60(11), 344–352. https://doi.org/10.3345/kjp.2017.60.11.344

Barrass

Kramer

(1999). Using sonification. Multimedia Systems, 7(1), 23–31. https://doi.org/10.1007/s005300050108

Cassidy

R. J.

Berger

Lee

Maggioni

Coifman

(2004). Auditory display of hyperspectral colon tissue images using vocal synthesis models. In Tenth Meeting of the International Conference on Auditory Display. Sydney, Australia. https://smartech.gatech.edu/bitstream/handle/1853/50777/CassidyBerger2004.pdf?sequence=1&isAllowed=y

Collett

Salisbury

Loeb

R. G.

Sanderson

P. M.

(2020). Smooth or stepped? Laboratory comparison of enhanced sonifications for monitoring patient oxygen saturation. Human Factors, 62(1), 124–137. https://doi.org/10.1177/0018720819845742

10.

Dawson

J. A.

Kamlin

C. O.

Vento

Wong

Cole

T. J.

Donath

S. M.

Davis

P. G.

Morley

C. J.

(2010). Defining the reference range for oxygen saturation for infants after birth. Pediatrics, 125(6), e1340–1347. https://doi.org/10.1542/peds.2009-1510

11.

Dawson

J. A.

Morley

C. J.

(2010). Monitoring oxygen saturation and heart rate in the early neonatal period. Seminars in Fetal & Neonatal Medicine, 15(4), 203–207. https://doi.org/10.1016/j.siny.2010.03.004

12.

Deschamps

M. L.

Sanderson

Hinckfuss

Browning

Loeb

R. G.

Liley

Liu

(2016). Improving the detectability of oxygen saturation level targets for preterm neonates: A laboratory test of tremolo and beacon sonifications. Applied Ergonomics, 56, 160–169. https://doi.org/10.1016/j.apergo.2016.03.013

13.

Escrig

Arruza

Izquierdo

Villar

Saenz

Gimeno

Moro

Vento

(2008). Achievement of targeted saturation values in extremely low gestational age neonates resuscitated with low or high oxygen concentrations: a prospective, randomized trial. Pediatrics, 121(5), 875–881. https://doi.org/10.1542/peds.2007-1984

14.

Fitch

W. T.

Kramer

(1994). Sonifying the body electric: Superiority of an auditory display over a visual display in a complex, multivariate system. In Kramer

(Ed.), Auditory display: Sonification, audification and auditory interfaces. Addison-Wesley.

15.

Gandhi

Rich

Finer

(2013). Achieving targeted pulse oximetry values in preterm infants in the delivery room. Journal of Pediatrics, 163(2), 412–415. https://doi.org/10.1016/j.jpeds.2013.01.010

16.

Goos

T. G.

Rook

van der Eijk

A. C.

Kroon

A. A.

Pichler

Urlesberger

Dankelman

Reiss

I. K.

(2013). Observing the resuscitation of very preterm infants: are we able to follow the oxygen saturation targets? Resuscitation, 84(8), 1108–1113. https://doi.org/10.1016/j.resuscitation.2013.01.025

17.

Gratton

Brandimonte

M. A.

Bruno

(2016). Absolute memory for tempo in musicians and non-musicians. PLoS One, 11(10), Article e0163558. https://doi.org/10.1371/journal.pone.0163558

18.

Hermann

Baier

Stephani

Ritter

(2006). Vocal sonification of pathological EEG features. 12th International Conference on Auditory Display, London, UK. https://smartech.gatech.edu/bitstream/handle/1853/50695/HermannBaier2006.pdf?sequence=1&isAllowed=y

19.

Hermann

Hunt

Neuhoff

J. G.

(2011). The sonification handbook. Logos Verlag.

20.

Hinckfuss

Sanderson

Brecknell

Loeb

R. G.

Liu

Liley

(2022). Evaluating enhanced pulse oximetry auditory displays for neonatal oxygen targeting: A randomized laboratory trial. Manuscript submitted for publication.

21.

Hinckfuss

Sanderson

Loeb

R. G.

Liley

H. G.

Liu

(2016). Novel pulse oximetry sonifications for neonatal oxygen saturation monitoring: A laboratory study. Human Factors, 58(2), 344–359. https://doi.org/10.1177/0018720815617406

22.

Johnson

P. A.

Schmölzer

G. M.

(2020). Heart rate assessment during neonatal resuscitation. Healthcare (Basel), 8(43). https://doi.org/10.3390/healthcare8010043

23.

Kent

R. D.

Vorperian

H. K.

(2018). Static measurements of vowel formant frequencies and bandwidths: A review. Journal of Communication Disorders, 74, 74–97. https://doi.org/10.1016/j.jcomdis.2018.05.004

24.

Leav

(2020). Monitoring neonatal vital signs in the first 10 minutes after birth: A novel auditory display. Honours Thesis, School of Psychology, School of Psychology, The University of Queensland. St Lucia QLD. https://espace.library.uq.edu.au/view/UQ:0a75812

25.

Lim

Wheeler

K. I.

Gale

T. J.

Jackson

H. D.

Kihlstrand

J. F.

Sand

Dawson

J. A.

Dargaville

P. A.

(2014). Oxygen saturation targeting in preterm infants receiving continuous positive airway pressure. The Journal of Pediatrics, 164(4), 730–736e731. https://doi.org/10.1016/j.jpeds.2013.11.072

26.

Loeb

R. G.

Brecknell

Sanderson

P. M.

(2016). The sounds of desaturation: A survey of commercial pulse oximeter sonifications. Anesthesia & Analgesia, 122(5), 1395–1403. https://doi.org/10.1213/ANE.0000000000001240

27.

Loeb

R. G.

Fitch

W. T.

(2002). A laboratory evaluation of an auditory display designed to enhance intraoperative monitoring. Anesthesia and Analgesia, 94(2), 362–368. https://doi.org/10.1097/00000539-200202000-00025

28.

Melara

R. D.

Marks

L. E.

(1990). Interaction among auditory dimensions: timbre, pitch, and loudness. Perception & Psychophysics, 48(2), 169–178. https://doi.org/10.3758/bf03207084

29.

Melara

R. D.

Marks

L. E.

(1990b). Perceptual primacy of dimensions: support for a model of dimensional interaction. Journal of Experimental Psychology: Human Perception and Performance, 16(2), 398–414. https://doi.org/10.1037//0096-1523.16.2.398

30.

Morley

C. J.

Davis

P. G.

(2008). Advances in neonatal resuscitation: supporting transition. Archives of Disease in Childhood-Fetal and Neonatal Edition, 93(5), F334–F336. https://doi.org/10.1136/adc.2007.128827

31.

Morris

R. W.

Mohacsi

P. J.

(2005). How well can anaesthetists discriminate pulse oximeter tones? Anaesthesia & Intensive Care, 33(4), 497–500. https://doi.org/10.1177/0310057X0503300412

32.

Oei

J. L.

Vento

(2019). Is there a “right" amount of oxygen for preterm infant stabilization at birth? Frontiers in Pediatrics, 7(September), Article 354. https://doi.org/10.3389/fped.2019.00354

33.

Paterson

Sanderson

P. M.

Brecknell

Paterson

N. A. B.

Loeb

R. G.

(2019). Comparison of standard and enhanced pulse oximeter auditory displays of oxygen saturation: A laboratory study with clinician and nonclinician participants. Anesthesia & Analgesia, 129(4), 997–1004. https://doi.org/10.1213/ANE.0000000000004267

34.

Peres

S. C.

(2012). A comparison of sound dimensions for auditory graphs: Pitch Is not so perfect. Journal of the Audio Engineering Society, 60(7–8), 561–567. http://www.aes.org/e-lib/browse.cfm?elib=16367

35.

Sanderson

P. M.

Loeb

R. G.

Liley

Liu

Paterson

Hinckfuss

Zestic

(2022). Signaling patient oxygen desaturation with enhanced pulse oximetry tones. Biomedical Instrumentation and Technology, 56(2), 46–57. https://doi.org/10.2345/1943-5967-56.2.46

36.

Sandor

Lane

D. M.

(2003). Sonification of absolute values with single and multiple dimensions. In International Conference on Audiotyr Display, Boston, MA. https://smartech.gatech.edu/handle/1853/50487

37.

Seagull

J. F.

Wickens

C. D.

Loeb

R. G.

(2001). When is less more? Attention and workload in auditory, visual, and redundant patient-monitoring conditions. In Proceedings of the Human Factors and Ergonomics Society 45th Annual Meeting.

38.

Watson

Sanderson

(2004). Sonification supports eyes-free respiratory monitoring and task time-sharing. Human Factors, 46(3), 497–517. https://doi.org/10.1518/hfes.46.3.497.50401

39.

White

L. N.

Thio

Owen

L. S.

Kamlin

C. O.

Sloss

Hooper

S. B.

Davis

P. G.

Dawson

J. A.

(2017). Achievement of saturation targets in preterm infants <32 weeks' gestational age in the delivery room. Archives of Disease in Childhood - Fetal & Neonatal Edition, 102(5), F423–F427. https://doi.org/10.1136/archdischild-2015-310311

40.

Woods

(1995). The alarm problem and directed attention in dynamic fault management. Ergonomics, 38(11), 2371–2393. https://doi.org/10.1080/00140139508925274

41.

Wyllie

(2006). Applied physiology of newborn resuscitation. Current Paediatrics 16(6), 379–385. https://doi.org/10.1016/j.cupe.2006.08.003

42.

Wyllie

Perlman

J. M.

Kattwinkel

Wyckoff

M. H.

Aziz

Guinsburg

Kim

H. S.

Liley

H. G.

Mildenhall

Simon

W. M.

Szyld

Tamura

Velaphi

Neonatal Resuscitation Chapter

(2015). Part 7: Neonatal resuscitation: 2015 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Resuscitation, 95, e169–201. https://doi.org/10.1016/j.resuscitation.2015.07.045

43.

Zestic

Brecknell

Liley

Sanderson

(2019). A novel auditory display for neonatal resuscitation: Laboratory studies simulating pulse oximetry in the first 10 minutes after birth. Human Factors, 61(1), 119–138. https://doi.org/10.1177/0018720818793769

44.

Zestic

Sanderson

Dawson

Liley

(2021). Defining information needs in neonatal resuscitation with work domain analysis. Journal of Clinical Monitoring and Computing, 35(4), 689–710. https://doi.org/10.1007/s10877-020-00526-7