Large deviations from oxygen saturation targets for preterm infants

Feb 12 2013

By Nikki Withers, medwireNews Reporter

Recommended oxygen saturation (SpO₂) targets are not always followed accurately during the first few minutes after the birth of preterm infants, show results of a study published in Resuscitation.

The researchers suggest that changing the current SpO₂ targets to a range that reflects acceptable deviation could aid physicians in providing better respiratory support for these infants.

The European Resuscitation Council (ERC) has published guidelines that provide SpO₂ targets for the first 10 minutes of resuscitation after birth (60, 70, 80, 85, and 90% at 2, 3, 4, 5, and 10 minutes after birth, respectively). However, the control of SpO₂ in newborn infants is difficult.

The investigators therefore aimed to determine to what extent SpO₂ levels matched ERC target levels during the resuscitation of very preterm infants immediately after birth. Their study included 78 infants with a gestational age of 30 weeks or less.

Tom Goos (Erasmus Medical Centre, Rotterdam, the Netherlands) and colleagues found that, during the first 10 minutes after birth, the time spent above and below the SpO₂ target was similarly distributed, at 44% and 51%, respectively. The median deviation above the target was 4.4%, while the median below was 8.2%.

After the first 10 minutes and up until the infant left the resuscitation area, SpO₂ levels were outside the neonatal intensive care unit's limits for 32% of the time - above the limit for 11% of the time and below for 8%. "Thus even with adequate respiratory support, remaining between the high and low SpO₂ levels was challenging," writes the team.

Goos et al suggest that the deviations observed during the first minutes of resuscitation "were likely caused by an inability to control the SpO₂, whereas later deviations were due to weaning, pauses in respiratory support (ie, intubation) and over-exposure to oxygen."

The researchers conclude that new technological developments, such as closed loop SpO₂ control, may help improve SpO₂ monitoring, as it would keep the physician free to focus on the infant instead of fine tuning the equipment.

Furthermore, "changing the SpO₂ targets to a target range that depicts the acceptable deviation might be helpful in providing better respiratory support," they say.

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