Elsevier

The Journal of Pediatrics

Volume 164, Issue 4, April 2014, Pages 730-736.e1
The Journal of Pediatrics

Original Article
Oxygen Saturation Targeting in Preterm Infants Receiving Continuous Positive Airway Pressure

https://doi.org/10.1016/j.jpeds.2013.11.072Get rights and content

Objective

The precision of oxygen saturation (SpO2) targeting in preterm infants on continuous positive airway pressure (CPAP) is incompletely characterized. We therefore evaluated SpO2 targeting in infants solely receiving CPAP, aiming to describe their SpO2 profile, to document the frequency of prolonged hyperoxia and hypoxia episodes and of fraction of inspired oxygen (FiO2) adjustments, and to explore the relationships with neonatal intensive care unit operational factors.

Study design

Preterm infants <37 weeks' gestation in 2 neonatal intensive care units were studied if they were receiving CPAP and in supplemental oxygen at the beginning of each 24-hour recording. SpO2, heart rate, and FiO2 were recorded (sampling interval 1-2 seconds). We measured the proportion of time spent in predefined SpO2 ranges, the frequency of prolonged episodes (≥30 seconds) of SpO2 deviation, and the effect of operational factors including nurse-patient ratio.

Results

A total of 4034 usable hours of data were recorded from 45 infants of gestation 30 (27-32) weeks (median [IQR]). When requiring supplemental oxygen, infants were in the target SpO2 range (88%-92%) for only 31% (19%-39%) of total recording time, with 48 (6.9-90) episodes per 24 hours of severe hyperoxia (SpO2 ≥98%), and 9.0 (1.6-21) episodes per 24 hours of hypoxia (SpO2 <80%). An increased frequency of prolonged hyperoxia in supplemental oxygen was noted when nurses were each caring for more patients. Adjustments to FiO2 were made 25 (16-41) times per day.

Conclusion

SpO2 targeting is challenging in preterm infants receiving CPAP support, with a high proportion of time spent outside the target range and frequent prolonged hypoxic and hyperoxic episodes.

Section snippets

Methods

We conducted a prospective observational study in preterm infants receiving CPAP and supplemental oxygen at 2 Australian tertiary neonatal centers, Royal Hobart Hospital (RHH), Hobart and Royal Women's Hospital, Melbourne (RWH). Both units use CPAP for initial and step-down respiratory support in preterm infants. CPAP is generated with either a bubble CPAP system (Fisher and Paykel HealthCare, East Tamaki, New Zealand) or a mechanical ventilator (Babylog 8000 plus, Dräger Medical Systems Inc,

Results

A total of 45 infants were studied, 32 at RHH, and 13 at RWH. Median gestation was 30 weeks (IQR 27-32 weeks), birth weight 1.3 (0.93-1.8) kg, and age at first recording 1 (0-8) days (Table I; available at www.jpeds.com). At the onset of each recording, infants were receiving support with a median CPAP level of 7 (6-8) cmH2O and FiO2 0.25 (0.22-0.29).

In all, 4113 hours of data were recorded, of which 79 hours (1.2%) were excluded for missing SpO2 signal. Of the 4034 hours of usable data, 2971

Discussion

Despite controversies regarding what the optimal SpO2 target range for preterm infants should be, the importance of SpO2 is indisputable, particularly when supplemental oxygen is being delivered. We evaluated SpO2 targeting in preterm infants receiving CPAP and found that when receiving oxygen, infants spent only 31% of the time in the target SpO2 range. Prolonged episodes of serious hypoxia, and of hyperoxia in oxygen, were relatively frequent, with hypoxic events more likely when nursing

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    Supported by the Royal Hobart Hospital Research Foundation, Hobart, Australia (starter grant 12-019). J.D. received an Australian National Health and Medical Research Council Post Doctoral Fellowship. The authors declare no conflicts of interest.

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