Safe oxygen saturation targeting and monitoring in preterm infants: can we avoid hypoxia and hyperoxia?
Augusto Sola1, Sergio G Golombek, María Teresa Montes Bueno
1Ibero American Society of Neonatology (SIBEN), Dana Point, CA, USA; New York Medical College, Valhalla, NY, USA.
Insights
Oxygen saturation targets for preterm infants are critical. Lower targets (85-89%) increase mortality, while higher targets (91-95%) risk hyperoxia, suggesting safer intermediate ranges like 87-94% may be necessary.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Clinical Trial Methodology
Background:
- Oxygen administration is a critical aspect of neonatal care, particularly for preterm infants.
- Previous studies have explored various oxygen saturation (SpO2) targets, but optimal ranges remain debated.
- Potential risks associated with both low and high SpO2 levels in neonates necessitate careful evaluation.
Purpose of the Study:
- To review and assess current oxygen saturation (SpO2) targeting strategies in preterm infants.
- To critically evaluate the methodologies and limitations of existing randomized clinical trials (RCTs) on this topic.
- To identify safer SpO2 target ranges for clinical practice in neonates.
Main Methods:
- Systematic review and critical appraisal of randomized clinical trials (RCTs) concerning SpO2 targeting in preterm infants.
- Analysis of data from international neonatology and nursing expert assessments.
- Evaluation of the potential weaknesses and biases in published RCTs.
Main Results:
- SpO2 targets of 85-89% were associated with increased mortality in preterm infants.
- SpO2 targets of 91-95% were linked to hyperoxia and adverse effects.
- Neither of these narrow ranges is recommended for clinical practice.
Conclusions:
- Current evidence does not support the use of SpO2 targets of 85-89% or 91-95% in preterm infants.
- Wider, intermediate SpO2 target ranges, such as 87-94% or 88-94%, may offer a safer approach.
- Further research is needed to confirm optimal SpO2 targeting to minimize risks and improve outcomes in preterm neonates.
Unlabelled:
Oxygen is a neonatal health hazard that should be avoided in clinical practice. In this review, an international team of neonatologists and nurses assessed oxygen saturation (SpO2 ) targeting in preterm infants and evaluated the potential weaknesses of randomised clinical trials.
Conclusion:
SpO2 of 85-89% can increase mortality and 91-95% can cause hyperoxia and ill effects. Neither of these ranges can be recommended, and wider intermediate targets, such as 87-94% or 88-94%, may be safer.
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