Supplementary Material for: Awareness of Racial Bias in Pulse Oximetry Among Practicing Neonatologists: A Cross-Sectional Survey

Introduction:
Pulse oximeters may systematically overestimate arterial oxygen saturation in neonates with darker skin pigmentation. We performed a survey in practicing neonatologists to explore knowledge of this bias and the implications for clinical care.
Methods:
An email survey was distributed assessing knowledge of melanin-related pulse oximeter bias, perceived clinical significance, and communication practices. Responses were compared to data from emergency medicine clinicians.
Results:
Survey results from 120 neonatologists showed that 45.0% agreed that bias exists in pulse oximetry based on skin pigmentation. Among respondents aware of the bias, less than half correctly identified its direction. Most clinicians reported no change in clinical management for dark-skinned neonates. Compared to emergency medicine clinicians, neonatologists changed clinical practice less often and rated discussions with families as less important.
Conclusion:
Awareness of pulse oximetry bias related to skin pigmentation remains limited among neonatologists, with low rates of modification to daily clinical practice.