Related Experiment Video
Updated: Jul 19, 2026
Use of an Integrated Low-Flow Anesthetic Vaporizer, Ventilator, and Physiological Monitoring System for Rodents
Published on: July 9, 2020
Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: the AVIOx study
James I Hagadorn1, Anne M Furey, Tuyet-Hang Nghiem
1Division of Neonatology, Connecticut Children's Medical Center, 282 Washington St, Hartford, CT 06106, USA. jhagadorn@ccmckids.org
Insights
Maintaining target oxygen saturation in premature infants is challenging, with most centers struggling to stay within prescribed ranges. Noncompliance was often due to saturation levels being too high, indicating a need for improved strategies.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Clinical Research
Background:
- Premature infants (< 28 weeks' gestation) require careful monitoring of oxygen saturation.
- Local policies set target ranges for pulse oximeter saturation in these vulnerable infants.
- Variability in achieving these targets can impact neonatal outcomes.
Purpose of the Study:
- To document achieved pulse oximeter saturation levels in infants born at < 28 weeks' gestation.
- To compare achieved levels with local policy targets.
- To identify factors associated with compliance to target saturation ranges.
Main Methods:
- Prospective, multicenter cohort study of infants < 28 weeks' gestation.
- Oximetry data collected for 72-hour periods in the first 4 weeks of life.
- Hierarchical modeling used to identify factors associated with target range compliance.
Main Results:
- 84 infants enrolled across 14 centers; mean gestational age 26 weeks.
- Median oxygen saturation was 95% for infants receiving respiratory support.
- Centers achieved target range compliance 16%-64% of the time; most noncompliance was above the target range.
Conclusions:
- Maintaining target oxygen saturation in extremely premature infants shows significant variability.
- Noncompliance, primarily high saturation levels, necessitates further research into improved management strategies.
- The impact of improved compliance on neonatal outcomes requires additional investigation.
Objective:
The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at < 28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range.
Methods:
Infants who were < 28 weeks' gestation and < or = 96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling.
Results:
Fourteen centers from 3 countries enrolled 84 infants with mean +/- SD birth weight of 863 +/- 208 g and gestational age of 26 +/- 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance.
Conclusions:
Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.
Related Concept Videos
01:24Pulse Oximetry
Purpose
Average SpO2 values are greater than 95%. If the readings fall below 90%, it indicates that...
01:19Guidelines For Measuring Vital Signs
Before taking a patient's vital signs, a nurse would consider and assess the patient's comfort level and ensure appropriate equipment is available.
01:19Special considerations while measuring oxygen saturation
Ensuring accuracy in vital sign recordings while prioritizing patient comfort and minimizing anxiety is important.
01:17Assessment of Diffusion and Perfusion
The Role of Diffusion in Respiration
Diffusion is the process by which molecules move from an area of higher concentration to an area of lower concentration. In the respiratory system, this principle...
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:16Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue, improving...