Masimo SET® Pulse Oximetry Performed Accurately on Hospitalized Newborns of All Skin Tones in Largest-Ever Prospective Real-World Study
NICU Study Adds to the Evidence Demonstrating SET®’s Accuracy in Challenging Real-World Settings, With No Clinically Significant Differences in Performance Across Skin Pigmentation Categories or Race and Zero Occult Hypoxemia in Black or Hispanic Newborns
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Masimo RD SET® Neo Pulse Oximetry Sensor
These promising results—from an
As Dr. Siefkes’ team points out, even when conducted prospectively, with real-world patients, past studies of pulse oximetry accuracy by skin tone in newborns have not used quantitative, objective measurements to classify pigmentation, or have other methodological shortcomings and limitations. Some prior studies have found that oxygen saturation measured by noninvasive pulse oximetry (SpO2) can overestimate arterial blood oxygen saturation (SaO2), which can lead to occult hypoxemia. Noting that accurate detection of hypoxemia is especially important in NICU patients, since it drives many care pathway decisions, the NeoPODS researchers thus set out to conduct a prospective accuracy study in this patient population, hospitalized NICU patients, with rigorous technical methodology: tightly paired, time-synchronized SpO2-SaO2 measurements and objectively classified skin pigmentation across a range of gestational ages using the same sensors and monitors for all patients. Their primary outcome was the mean bias between paired, simultaneously measured SpO2 and SaO2 values, and their secondary outcome, understanding how that bias differed by skin tone.
The researchers enrolled patients between
From among 100 newborns enrolled over the three years, 136 paired SpO2-SaO2 readings collected from 70 patients met the technical criteria for inclusion in the final analysis. The patients’ median gestational age was 28.4 weeks and median gestational weight was 1085 grams (very low birth weight). As identified by their parents, 40% of the patients were Black and 23% were Hispanic. As objectively assessed, their skin pigmentations spanned the full range of ITA classifications and most, but not the darkest, points of the Massey-Martin and Fitzpatrick scales.
The researchers found that overall mean bias between noninvasive SpO2 and invasive SaO2 was -0.98% 2.80% (95% confidence interval, -1.45% to -0.52%), which is not a clinically significant amount, and means that, on average, SpO2 slightly underestimated, not overestimated, SaO2. In fact, there was only one data pair meeting the definition of occult hypoxemia (SaO2<88% when SpO2≥92%), collected from a patient with the lightest ITA skin tone classification; there were zero cases of occult hypoxemia among Black or Hispanic patients.
Turning to accuracy by skin pigmentation, the researchers found that across the objective classification measurements, as well as parent-reported race, there were no statistically or clinically significant differences in mean SpO2-SaO2 bias. For melanin index and ITA classification, when analyzed continuously, bias became slightly less negative with lighter skin pigmentation, but with statistical significance only when ITA analysis was restricted to each patient’s first measurement. There was no significant difference in bias comparing the 3 darkest to the 3 lightest ITA classifications, with all categories except the lightest showing a small negative bias and no statistically significant trend in bias with increasing darkness or lightness. Analyzing bias by Fitzpatrick and Massey-Martin classifications, the researchers similarly found no statistically significant differences (including when analysis was restricted to the first data pair per patient).
The authors concluded that their study is “a novel prospective study of newborns using objective skin pigmentation and closely paired SpO2 and SaO2 measurements assessing pulse oximeter accuracy across skin tones. Our study did not find clinically meaningful pigmentation-related bias. We believe this study provides some reassurance on equitable and accurate care in the NICU for this specific device and population. Our study supports the need for additional age-specific and device-specific pulse oximeter performance assessments.”
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References
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Siefkes H, Holla I, Giusto E, Tancredi D, and Lakshminrusimha S. Neonatal Pulse Oximetry Accuracy and Disparities by Skin Pigmentation (NeoPODS): A Prospective Study. J Ped.
21 Apr 2026 . doi: 10.1016/j.jpeds.2026.115114 -
Travers A, Terry C, Merrell W, Heincelman M, Warden A, Goodwin A. INSPIRE: Feasibility of a Study Examining the Effect of Skin Pigment on Pulse Oximetry. CHEST
Crit Care .10 Sept 2025 . DOI: 10.1016/j.chstcc.2025.100209. -
Sharma V, Barker S, Sorci R, Park L, Wilson W. Racial effects on Masimo pulse oximetry: impact of low perfusion index. J Clin Monit Comput.
19 Jan 2024 . https://doi.org/10.1007/s10877-023-01113-2. - Barker SJ, Wilson WC. Racial effects on Masimo pulse oximetry: a laboratory study. J Clin Monit Comput. 2023 Apr;37(2):567-574. https://doi.org/10.1007/s10877-022-00927-w.
- Foglia EE, Whyte RK, Chaudhary A, Mott A, Chen J, Propert KJ, Schmidt B. The Effect of Skin Pigmentation on the Accuracy of Pulse Oximetry in Infants with Hypoxemia. J Pediatr. 2017 Mar;182:375-377.e2. https://doi.org/10.1016/j.jpeds.2016.11.043.
- Marlar AI, Knabe BK, Taghikhan Y, Applegate RL, Fleming NW. Performance of pulse oximeters as a function of race compared to skin pigmentation: a single center retrospective study. J Clin Monit Comput. 2025 Feb;39(1):119-125. https://doi.org/10.1007/s10877-024-01211-9.
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Pulse Oximeters for Medical Purposes – Non-Clinical and Clinical Performance Testing, Labeling, and Premarket Submission Recommendations. Draft Guidance for Industry and
Food and Drug Administration Staff.January 7, 2025 .
About Masimo
Masimo (NASDAQ: MASI) is a global medical technology company that develops and produces a wide array of industry-leading monitoring technologies, including innovative measurements, sensors, patient monitors, and automation and connectivity solutions. Our mission is for our innovations to empower clinicians to transform patient care. Masimo SET® Measure-through Motion and Low Perfusion™ pulse oximetry, introduced in 1995, has been shown to outperform other pulse oximetry technologies in over 100 independent and objective studies, which can be found at www.masimo.com/evidence/featured-studies/feature. Masimo SET® is estimated to be used on more than 200 million patients around the world each year and is the primary pulse oximetry at all 10 top
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