Targeted oxygen therapy in special care nurseries: is uniformity a good thing?

Area of Science:

• Neonatal care
• Respiratory distress management
• Oxygen therapy protocols

Background:

• Wide variation exists in oxygen commencement (FiO2) and saturation (SpO2) targets in special care nurseries (SCNs).
• Minimizing unnecessary oxygen exposure is supported by current evidence.
• Standardizing oxygen management protocols is crucial for infant respiratory care.

Purpose of the Study:

• To evaluate if a uniform protocol for commencing inspired oxygen (FiO2) at 30% and targeting SpO2 of 94-96% reduces oxygen exposure in infants ≥ 33 weeks gestation with respiratory distress.
• To assess the impact of the protocol on the proportion of infants receiving oxygen and duration of exposure.
• To analyze the protocol's effectiveness across different gestational age groups.

Main Methods:

• A 'Before After' study design was implemented across three SCNs.
• Data were collected for infants requiring oxygen over a 3-year period.
• Infants were categorized into gestational age groups: 33-36 weeks (late preterm) and ≥37 weeks (term/post-term).

Main Results:

• The oxygen-targeting protocol led to a significant reduction in infants treated with oxygen for ≥1 hour or ≥4 hours (P ≤ 0.01).
• A significant decrease was observed in infants receiving >30% FiO2 for ≥1 hour (P ≤ 0.01).
• Median oxygen duration for term/post-term infants decreased from 12 to 10 hours (P=0.01), but no significant difference was found for preterm infants (11 to 8 hours, P=0.07).

Conclusions:

• Implementing a uniform oxygen protocol in SCNs for infants ≥ 33 weeks gestation with respiratory distress effectively reduces the number of infants requiring oxygen.
• The protocol significantly decreases oxygen exposure duration in term infants.
• Further investigation may be needed to optimize oxygen protocols for preterm infants.