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Oxygen saturation monitoring for the preterm infant: the evidence basis for current practice
1Department of Neonatology, University of California, San Diego Medical Center, San Diego, California 92103, USA. nfiner@ucsd.edu
Insights
Optimal oxygen saturation for very preterm infants is crucial. Initial resuscitation uses 30-40% oxygen, followed by targeted SpO2 of 85-93% for ongoing care to manage free radical-related morbidities.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Extreme immaturity in infants increases susceptibility to morbid conditions due to free radical excess and low antioxidant levels.
- Optimal oxygen saturation levels for very low birth weight (VLBW) infants during resuscitation, stabilization, and ongoing care are not well-defined.
- Clinical oxygen use in newborns requires further evidence-based guidelines.
Purpose of the Study:
- To review current evidence on clinical oxygen use in the newborn period.
- To define optimal oxygen saturation targets for very preterm infants.
- To guide resuscitation and ongoing management strategies for VLBW infants.
Main Methods:
- Systematic review of available evidence on clinical oxygen use in newborns.
- Analysis of studies concerning oxygen saturation targets in preterm infants.
- Evaluation of current practices in neonatal intensive care.
Main Results:
- Initial resuscitation for very preterm infants should involve 30-40% oxygen with targeted SpO2 values and blended oxygen for the first 10 minutes.
- For ongoing management, SpO2 targets of 85-93% are considered most appropriate for preterm infants.
- Current evidence does not strongly support altered oxygen limits for retinopathy of prematurity in its early stages.
Conclusions:
- A pragmatic approach to resuscitation includes initial blended oxygen (30-40%) and targeted SpO2 for very preterm infants.
- Ongoing care for preterm infants should aim for SpO2 levels between 85-93%.
- Further prospective studies are necessary to determine the long-term outcomes associated with varied oxygen targets.
Abstract:
Many of the morbid conditions associated with extreme immaturity are potentiated by an excess of free radicals occurring in infants who developmentally have decreased levels of antioxidants. The optimal oxygen saturation values for the resuscitation, stabilization, and ongoing care of the very low birth weight infant remain largely undefined. We have reviewed the currently available evidence for clinical oxygen use in the newborn period. Until the results of further studies are available, a reasonable approach to resuscitation would include initial resuscitation with 30-40% oxygen for very preterm infants using targeted SpO2 values and blended oxygen during the first 10 min. For ongoing management of preterm infants, SpO2 targets of 85-93% seem to be most appropriate, with alarm limits set within 1 to 2% of these targets with intermittent audits to ensure compliance. There is no strong evidence to support the use of altered limits for the infant who develops early evidence of retinopathy of prematurity. Further prospective studies are required to evaluate the effects of varied oxygen targets on long-term outcome.
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