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Original article
Effect of a smaller target range on the compliance in targeting and distribution of oxygen saturation in preterm infants
  1. Henriëtte Anje van Zanten1,
  2. Steffen C Pauws1,2,
  3. Ben J Stenson3,
  4. Frans J Walther1,
  5. Enrico Lopriore1,
  6. Arjan B te Pas1
  1. 1 Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  2. 2 TiCC, Tilburg University, Tilburg, Noord-Brabant, The Netherlands
  3. 3 Neonatal Unit, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
  1. Correspondence to Henriëtte Anje van Zanten, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC Leiden, The Netherlands; h.a.van_zanten{at}lumc.nl

Abstract

Background Following recent recommendations, the oxygen saturation (SpO2) target range for preterm infants in our nursery was narrowed towards the higher end from 85%–95% to 90%–95%. We determined the effect of narrowing the SpO2 target range on the compliance in target range and distribution of SpO2 in preterm infants.

Methods Before and after changing the target range from 85%–95% to 90%–95%, infants <30 weeks of gestation receiving oxygen were compared during their admission on the neonatal intensive care unit. For each infant, distribution of SpO2 was noted by collecting SpO2 samples each minute, and the percentage of time spent with SpO2 within 90%–95% was calculated. Oxygen was manually adjusted. Hypoxaemic events (SpO2 <80%) where oxygen was titrated were analysed.

Results Data were analysed for 104 infants (57 before and 47 after the range was narrowed). The narrower range was associated with an increase in the median (IQR) SpO2 (93% (91%–96%) vs 94% (92%–97%), p=0.01), but no increase in median time SpO2 within 90%–95% (49.2% (39.6%–59.7%) vs (46.9% (27.1%–57.9%), p=0.72). The distribution of SpO2 shifted to the right with a significant decrease in SpO2 <90%, but not <80%. The count of minute values for Sp02 <80% decreased, while the frequency and duration of hypoxaemic events and oxygen titration were not different.

Conclusion Narrowing the target range from 85%–95% to 90%–95% in preterm infants was associated with an increase in median SpO2 and a rightward shift in the distribution, but no change in time spent between 90% and 95%.

  • preterm infant
  • supplemental oxygen
  • target range
  • hypoxaemia
  • hyperoxaemia

https://doi.org/10.1136/archdischild-2016-312496

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    Footnotes

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    • Contributors HAvZ was the executive researcher of the study. She performed literature search, data collection, data analysis, data interpretation, writing and submitting of the manuscript. SCP was involved in data analysis, critically reviewed the manuscript and approved the final version. BJS was involved in interpretation of the data, critically reviewed the manuscript and approved the final version. EL critically reviewed the manuscript and approved the final version. FJW critically reviewed the manuscript and approved the final version. ABtP was the project leader and performed literature search, designed the study, and coordinated data analysis, data interpretation, writing, editing and submitting of the manuscript.

    • Competing interests None declared.

    • Ethics approval LUMC Medical Ethics Committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.