Background To reduce the risks of hypoxia and hyperoxia in preterm infants in the delivery room; national and international guidelines recommend titrating supplemental oxygen delivery to achieve specific oxygen saturation (SpO2) targets. Our aim was to measure the proportion of time infants <32 weeks' gestation spent within and outside prescribed SpO2 targets during the first 10 min after birth.
Method Prospective observational study using data from a preductal SpO2 sensor and oxygen analyser measuring fraction of inspired oxygen (FiO2) in the inspiratory limb of the respiratory circuit. Measurements of SpO2, heart rate and FiO2 were recorded every 2 s. We assessed compliance with the upper SpO2 limit only when infants were receiving supplemental oxygen. SpO2 measurements were recorded as being below, within or above the target at each time point. We measured the number of times infants were continuously below or above the target range for more than 30 s.
Results Twenty-seven infants; mean (SD) 28 (3.4) weeks and 962 (370) g were studied. Infants were below, within and above the prescribed targets for 28%, 35% and 37% of the first 10 min after birth, respectively.
Conclusions Preterm infants spent almost two-thirds of the first 10 min after birth with oxygen saturations outside prescribed target ranges. New titration strategies are required to reduce the risks of hypoxia and hyperoxia.
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Contributors LNW: collected, analysed and interpreted data, drafted the manuscript. JAD: conceived the study contributed to study design, collected, analysed and interpreted data, drafted the manuscript. MT, LSO, SBH and COK: contributed to study design, data interpretation and drafting the manuscript. SS: contributed to data collection. PGD: contributed to study design, data interpretation, drafting the manuscript, supervision of all aspects of the study. All authors approved the final version of the manuscript.
Funding JAD, LSO, MT and COK are recipients of a National Health and Medical Research Council (NHMRC) Postdoctoral Fellowship and who are supported by the Victorian Government's Operational Infrastructure Support Program. PGD and SBH are recipients of an NHMRC Practitioner and Principal Research Fellowship, respectively. The study was supported in part by NHMRC Program Grant No. 384100.
Competing interests None declared.
Ethics approval RWH Research and Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
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