Improving manual oxygen titration in preterm infants by training and guideline implementation

Area of Science:

• Neonatal Medicine
• Respiratory Physiology
• Clinical Training

Background:

• Oxygen saturation (SpO2) targeting in preterm infants (<30 weeks gestation) is critical but challenging.
• Manual oxygen titration often results in low compliance and frequent hyperoxaemia, especially during apneas of prematurity, hypoventilation, and choking (ABCs).

Purpose of the Study:

• To evaluate the impact of training and guideline implementation on manual oxygen titration for SpO2 targeting in preterm infants.
• To assess changes in time spent within the target SpO2 range (85-95%) and the incidence/duration of hyperoxaemia and hypoxaemia.

Main Methods:

• A comparative study of two cohorts of preterm infants (<30 weeks gestation) requiring respiratory support and oxygen therapy before and after intervention.
• Calculation of percentage of time SpO2 was within the target range (%SpO2-wtr) and analysis of SpO2 excursions outside the target range during ABCs.

Main Results:

• Improved SpO2 targeting, with %SpO2-wtr increasing from 48.0% to 61.9% (p < 0.005).
• Reduced hyperoxaemia, with %SpO2 > 95% decreasing from 44.0% to 30.8% (p < 0.05), and shorter durations of hyperoxaemia during ABCs.
• No significant change in %SpO2 < 85% or %SpO2 < 80%, but a reduction in the duration of SpO2 < 80% during ABCs.

Conclusions:

• Training and guideline implementation significantly improved SpO2 targeting in preterm infants.
• The intervention led to more time within the target SpO2 range and reduced hyperoxaemia, enhancing safety during respiratory support.