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Updated: May 28, 2026
Biochemical Measurement of Neonatal Hypoxia
Published on: August 24, 2011
An observational study to quantify manual adjustments of the inspired oxygen fraction in extremely low birth weight
Anne Catherine van der Eijk1, Jenny Dankelman, Sander Schutte
1Department of BioMechanical Engineering, Faculty of Mechanical, Maritime & Materials Engineering, Delft University of Technology, The Netherlands. a.c.vandereijk@tudelft.nl
Insights
Caregiver adjustments to fraction of inspired oxygen (FiO2) in extremely low birth weight infants varied significantly. Large FiO2 changes were linked to bedside procedures, posing challenges for automated systems.
Area of Science:
- Neonatal intensive care
- Respiratory support in preterm infants
- Clinical nursing practices
Background:
- Extremely low birth weight (ELBW) infants require precise oxygen management.
- Manual adjustments of fraction of inspired oxygen (FiO2) by caregivers are common.
- Variability in manual FiO2 adjustments may impact infant outcomes.
Purpose of the Study:
- To quantify manual FiO2 adjustments by caregivers in ELBW infants.
- To analyze these adjustments in relation to oxygen saturation (SpO2) and bedside care.
- To assess the consistency of FiO2 adjustments during clinical care.
Main Methods:
- Continuous recording of FiO2, SpO2, and alarm limits for ELBW infants over 3 days.
- Filming of caregiver interactions at the bedside.
- Descriptive analysis focusing on manual FiO2 adjustments and their association with SpO2 levels and procedures.
Main Results:
- Significant variability in the frequency and magnitude of manual FiO2 adjustments was observed.
- Large FiO2 adjustments (≥15%) and deep desaturations (<70% SpO2) were frequently associated with medical or nursing procedures.
- Inconsistent adherence to SpO2 alarm limit protocols (88-94%) was noted, with infants spending considerable time outside the target range.
Conclusions:
- Manual FiO2 adjustments in ELBW infants are highly variable and procedure-dependent.
- The significant association between procedures and large FiO2 changes highlights clinical challenges.
- Implementing these complex manual adjustments into automated systems presents a significant challenge.
Aim:
To quantify manual fraction of inspired oxygen (FiO(2)) adjustments performed by caregivers in extremely low birth weight (ELBW; ≤1000 g) infants, in relation to oxygen saturation (SpO(2)) and bedside care.
Methods:
In a single-centre study, FiO(2) , SpO(2) and alarm limits of ELBW infants were collected for 3 days continuously, while caregivers were filmed. A descriptive analysis, focused on manual FiO(2) adjustments, was performed.
Results:
Twelve ELWB infants were included. Total recording time was 726 h. FiO(2) was increased 851 times and decreased 1309 times; median (range) step size was 5% (1% to 65%) and -3% (-1% to -65%), respectively. Wide variation of FiO(2) adjustments for equal levels of SpO(2) was observed in all included infants. One hundred and twenty-six of 136 FiO(2) adjustments with a step size ≥15% and 111 of 171 desaturations <70% were associated with medical or nursing procedures. When FiO(2) was >21%, alarm limits for SpO(2) were set according to protocol (88-94%) in 64% of the time. Within these periods, SpO(2) was >94% for 30% and <88% for 16% of the time.
Conclusions:
Manual FiO(2) adjustments varied widely in frequency and step size. Deep desaturations and large FiO(2) adjustments were associated with medical or nursing procedures. When large adjustments are really necessary, it will be challenging to implement them in an automatic adjustment device.
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