Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Increased risk of pulse oximeter bias in Black versus White preterm infants

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Data availability

Data sharing is not applicable to this article as no new data were created or analyzed in this commentary. The data supporting the findings of the original study on which this commentary is based are available within the article and its supplementary materials at


  1. Vesoulis Z, Tims A, Lodhi H, Lalos N, Whitehead H. Racial discrepancy in pulse oximeter accuracy in preterm infants. J Perinatol. 2022;42:79–85.

    Article  Google Scholar 

  2. Tin W, Lal M. Principles of pulse oximetry and its clinical application in neonatal medicine. Semin Fetal Neonatal Med. 2015;20:192–7.

    Article  Google Scholar 

  3. Carlo WA, Finer NN, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Target ranges of oxygen saturation in extremely preterm infants. N. Engl J Med. 2010;362:1959–69.

    Article  CAS  Google Scholar 

  4. Stenson BJ, Tarnow-Mordi WO, Darlow BA, Simes J, Juszczak E, Askie L, et al. Oxygen saturation and outcomes in preterm infants. N. Engl J Med. 2013;368:2094–104.

    Article  Google Scholar 

  5. Anderson JG, Rogers EE, Baer RJ, Oltman SP, Paynter R, Partridge JC, et al. Racial and Ethnic Disparities in Preterm Infant Mortality and Severe Morbidity: A Population-Based Study. Neonatology 2018;113:44–54.

    Article  Google Scholar 

  6. Karvonen KL, Baer RJ, Rogers EE, Steurer MA, Ryckman KK, Feuer SK, et al. Racial and ethnic disparities in outcomes through 1 year of life in infants born prematurely: a population based study in California. J Perinatol. 2021;41:220–31.

    Article  Google Scholar 

  7. Sjoding MW, Dickson RP, Iwashyna TJ, Gay SE, Valley TS. Racial bias in pulse oximetry measurement. N. Engl J Med. 2020;383:2477–8.

    Article  Google Scholar 

  8. Wong AI, Charpignon M, Kim H, Josef C, de Hond AAH, Fojas JJ, et al. Analysis of discrepancies between pulse oximetry and arterial oxygen saturation measurements by race and ethnicity and association with organ dysfunction and mortality. JAMA Netw Open. 2021;4:e2131674.

    Article  Google Scholar 

  9. Valbuena VSM, Barbaro RP, Claar D, Valley TS, Dickson RP, Gay SE, et al. Racial bias in pulse oximetry measurement among patients about to undergo extracorporeal membrane oxygenation in 2019-2020: A retrospective cohort study. Chest. 2021.

  10. Olusanya BO, Imosemi DO, Emokpae AA. Differences between transcutaneous and serum bilirubin measurements in black African neonates. Pediatrics. 2016;138.

  11. Foglia EE, Whyte RK, Chaudhary A, Mott A, Chen J, Propert KJ, et al. The Effect of Skin Pigmentation on the Accuracy of Pulse Oximetry in Infants with Hypoxemia. J Pediatr. 2017;182:375–7.e2.

    Article  Google Scholar 

  12. Patel P, Houck A, Fuentes D. Examining Variations in Surfactant Administration (ENVISION): A Neonatology Insights Pilot Project. Children (Basel). 2021;8.

  13. Center for Devices and Radiological Health. Pulse Oximeters - Premarket Notification Submissions [510(k)s] Guidance for Industry and Food and Drug Administration Staff. U.S. Department of Health and Human Services; 2013.

  14. Giavarina D. Understanding Bland Altman analysis. Biochem Med (Zagreb). 2015;25:141–51.

    Article  Google Scholar 

  15. Bland JM, Altman DG. Agreement between methods of measurement with multiple observations per individual. J Biopharm Stat. 2007;17:571–82.

    Article  Google Scholar 

  16. Gerke O. Reporting standards for a Bland-Altman agreement analysis: A review of methodological reviews. Diagnostics (Basel). 2020;10.

  17. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res. 1999;8:135–60.

Download references


The Journal Club is a collaboration between the American Academy of Pediatrics – Section of Neonatal-Perinatal Medicine and the International Society for Evidence-based neonatology (

Author information

Authors and Affiliations



Literature search, article selection, evidence-based lesson selection, formal analysis, and writing (original draft, review, and editing) by CLG. Statistical consultation of the discussion and the evidence-based lesson and critical manuscript review by NLW. Supervision, article selection assistance, and writing (review and editing) by EVS.

Corresponding author

Correspondence to Charles L. Groomes.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Groomes, C.L., Watson, N.L. & Schulz, E.V. Increased risk of pulse oximeter bias in Black versus White preterm infants. J Perinatol (2022).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI:


Quick links