Related Experiment Videos
When do infants need additional inspired oxygen? A review of the current literature
1Department of Pediatric Pulmonology, Medizinische Hochschule, Hannover, Germany. Poets.Christian@MH-Hannover.de
Insights
For infants with lung disease, maintaining oxygen saturation (SpO2) above 93% is recommended. Higher SpO2 levels (≥95%) at home may reduce sudden infant death and improve weight gain.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Respiratory Physiology
Background:
- Uncertainty exists regarding optimal oxygen saturation thresholds for infants with acute or chronic lung disease.
- Current recommendations rely on healthy infant values and observational data on hypoxia effects.
Purpose of the Study:
- To review existing data and provide recommendations for oxygen saturation thresholds in infants with lung disease.
- To establish target SpO2 levels for both inpatient and home oxygen therapy.
Main Methods:
- Review of reference values for healthy infants' pulse oximeter saturations (SpO2).
- Analysis of observational studies on the effects of oxygen administration in infants with chronic lung disease (CLD).
Main Results:
- Healthy infants typically maintain SpO2 between 93-97%.
- In CLD infants, maintaining SpO2 ≥93% reduced sudden infant death rates and improved weight gain (93-95%).
- Oxygen therapy lowered pulmonary artery pressure (82% to 93% SpO2), decreased airway resistance (89% SpO2), and reduced hypoxemic episodes (≥90% SpO2).
Conclusions:
- Oxygen therapy should be considered for infants with baseline SpO2 <93%.
- Target SpO2 of ≥95% is recommended for home management of infants with lung disease.
Abstract:
There is considerable uncertainty regarding the oxygen saturation threshold below which additional inspired oxygen should be given to infants with acute or chronic lung disease. In the absence of data from controlled studies, recommendations can only be based on reference values for healthy infants and on observational studies regarding the pathophysiological effects of acute and chronic hypoxia. Reference values for pulse oximeter saturations (SpO2) in term and preterm infants show that during normal breathing 95% of infants maintain SpO2 at or above 93-97%, depending on age. Studies of infants with chronic lung disease (CLD) show that (1) when SpO2 was kept at > or =93% by administration of home oxygen, rates of sudden infant death were reduced; (2) weight gain was significantly better when SpO2 was maintained at > or =93-95%, (3) increasing SpO2 from 82 to 93% by delivering low-flow oxygen resulted in a 50% reduction in pulmonary artery pressure, (4) O2 administration to mildly hypoxemic infants (SPO2 89%) caused a 50% decrease in airway resistance, and (5) low-flow oxygen reduced the frequency of intermittent hypoxemic episodes, even in infants who had values of > or =90% at rest. Based on these data, it is recommended that oxygen therapy should be considered in infants whose baseline SpO2 is <93%, and that SpO2 should be maintained at > or =95% when infants are managed at home.