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Oxygen saturation centiles in healthy preterm neonates in the first 10 min of life: a prospective observational study

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Abstract

Current oxygen saturation targets in delivery room given by Neonatal Resuscitation Program (NRP) are essentially derived from term neonates. This prospective observational study was conducted in a level-III neonatal unit in preterm neonates (< 37 weeks) who did not receive resuscitation or supplemental oxygen to create centile charts for pre-ductal oxygen saturations using robust statistical modelling methods. Pre-ductal oxygen saturations (SPO2) were recorded from birth till 10 min of age using current generation Masimo pulse oximeters. Centile charts were created by generalized additive models. The change in oxygen saturations over time across subjects was modelled as a Bayesian linear regression mixed-effects model after including ‘a priori’ covariates. Oxygen saturation data was analysed in 180 subjects with mean gestation of 34 ± 2 weeks. Mean (SD) time to first SPO2 was 167 ± 77 s. The median time to SPO2 of > 90% was 310 s (IQR: 235–400). Time to > 90% SPO2 was shorter in (a) 34–36 weeks compared to < 34 weeks (290 vs 340; p = 0.03) and (b) vaginally delivered compared to caesarean-section born neonates (300 vs 360; p = 0.2).

    Conclusions: Oxygen saturations in first 10 min of age in healthy preterm neonates are significantly higher than the targets proposed by the NRP-2020. Larger preterm neonates and those born through vaginal route attained a preductal saturation of > 90% sooner.

What is Known:

• Pulse oximetry is the standard for oxygen saturation monitoring during immediate postnatal period.

• Healthy term neonates take many minutes after birth to reach a pre-ductal saturation of >90%. But, postnatal oxygen saturation trend data in healthy preterm neonates are scarce.

What is New:

• Provides centile charts for oxygen saturations till 10 minutes of age using current generation Masimo pulse oximeters in a large cohort of healthy preterm neonates using robust statistical modelling methods.

• Identifies covariates that significantly modifies the saturation trends using a Bayesian mixed models’ regression.

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Data availability

Patient data and the codes used for data analysis shall be provided on reasonable request to the email address of the corresponding author.

Abbreviations

DR:

Delivery room

GAIC:

General Akaike information criteria

GAMLSS:

Generalized Additive Models for Location, Scale, and Shape

IQR:

Interquartile range

LNCS:

Low Noise Cabled Sensors

MAR:

Missing at random

MGRS:

Multicentre Growth Reference Study

NRP:

Neonatal Resuscitation Program

SPO2:

Oxygen saturation

STOF:

Sensor to the Oximetry First

SET:

Signal extraction technology

SD:

Standard deviation

WHO:

World Health Organization

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Acknowledgements

We sincerely acknowledge Prof Stasinopoulos D Mikis for his valuable assistance in the creation of centile charts.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012

    Purna Chandra, Venkataseshan Sundaram & Praveen Kumar

Authors
  1. Purna Chandra
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  2. Venkataseshan Sundaram
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  3. Praveen Kumar
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Contributions

All the authors contributed to the study conception and design. Material preparation and data collection were performed by Purna Chandra. Analysis was performed by Venkataseshan Sundaram and Praveen Kumar. The first draft of the manuscript was written by Purna Chandra, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Venkataseshan Sundaram.

Ethics declarations

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Institute (NK/2735/MD/3766–67).

Consent to participate 

An informed consent was obtained from all eligible women in their antepartum period. 

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Gregorio Milani.

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Chandra, P., Sundaram, V. & Kumar, P. Oxygen saturation centiles in healthy preterm neonates in the first 10 min of life: a prospective observational study. Eur J Pediatr 182, 1637–1645 (2023). https://doi.org/10.1007/s00431-023-04838-z

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