Oxygen saturation limits and evidence supporting the targets

Supplemental oxygen use in the preterm infant is required for survival. Evidence supports a narrow therapeutic window between the helpful and harmful effects of supplemental oxygen in this vulnerable population. The clinical question was-what are the recommended oxygen saturation targets for the preterm infant and the preterm infant corrected to term? Multiple databases were searched for published research in English from 2008 to 2014 using key search terms. A total of 18 articles met inclusion criteria. Early neonatal research linked high levels of supplemental oxygen with retinopathy of prematurity and blindness. Years later, correlations between high arterial oxygen levels and oxidative stress leading to pulmonary and/or neurologic insults were established. Three large multicentered, international studies have recently been published (BOOST II, COT, and SUPPORT), which support oxygen saturation target ranges of 87% to 94% until vascular maturation of the retina is achieved. Two of the 3 studies reported a significant correlation between low saturation limits (85%-89%) and death in the extremely preterm population. Identified best care strategies to prevent states of hypoxia and/or hyperoxia include establishing clear target saturation limits according to recommendations, which are supported by the multidisciplinary team, adequate nurse to patient ratio, improve knowledge deficits, improve bedside compliance, and finally visual cues to remind caregivers of target saturation ranges.