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Adherence to oxygen saturation targets increased in preterm infants when a higher target range and tighter alarm

S Klevebro1,2, U Hammar3, G Holmström4

  • 1Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.

Acta Paediatrica (Oslo, Norway : 1992)
|April 6, 2019
PubMed

Insights

New guidelines for preterm infants increased target oxygen saturation. This led to more time within the desired range but also increased hyperoxemia, impacting clinical practice in neonatal intensive care.

Area of Science:

  • Neonatalogy
  • Pediatric Intensive Care
  • Respiratory Physiology

Background:

  • European consensus guidelines in May 2013 recommended a peripheral capillary oxygen saturation (SpO2) target of 90-95% for preterm infants.
  • These recommendations were adopted by Karolinska University Hospital in November 2013, necessitating a review of clinical practice.

Purpose of the Study:

  • To compare clinical practice and outcomes for preterm infants before and after the implementation of new local guidelines for oxygen saturation targets.
  • To evaluate the impact of a higher SpO2 target range (90-95%) compared to a previous lower range (88-92%) on oxygen saturation levels and adherence.

Main Methods:

  • A retrospective study included 399 preterm infants (23+0 to 30+6 weeks gestation) admitted to two Karolinska University Hospital intensive care units between January 2013 and December 2015.
  • Clinical practice was compared between two periods: before November 2013 (lower target 88-92%, alarm limits 85-95%) and after November 2013 (higher target 90-95%, alarm limits 89-96%).

Main Results:

  • The mean SpO2 was higher with the new target (92.4%) compared to the old target (91.1%).
  • Infants under the higher target spent more time within the prescribed SpO2 range (51% vs. 30%).
  • The proportion of time with SpO2 >95% increased by 9% (p < 0.001) with the higher target.

Conclusions:

  • Implementation of the higher oxygen saturation target and tighter alarm limits resulted in higher mean SpO2 levels.
  • Adherence to the target range improved, but there was also a significant increase in the duration of hyperoxemia (SpO2 >95%).
  • These findings highlight the trade-offs associated with adjusting oxygen saturation targets in preterm infants.
Abstract

Keywords:
OxygenationPreterm infantsPulse oximetryRetinopathy of prematuritySaturation target

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