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Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants
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  • Published on: 16 August 2018
    Response to Hewson M, Resuscitation saturation targets
    • Ju Lee Oei, Neonatologist University of New South Wales
    • Other Contributors:
      • Neil Finer, Neonatologist
      • Maximo Vento, Neonatologist
      • Yacov Rabi, Neonatologist
      • Ola Saugstad, Neonatologist

    We thank Dr Hewson for his interest in our paper and for raising several intriguing points that challenges current practice about the use of oxygen during the very important first minutes of life of a sick preterm infant. There are several points we would like to clarify in response to his questions.

    Firstly, in our study, only 12% (n=96) of preterm infants from the 8 studies reached the recommended SpO2 range (80-85%) and not the lower limit (80%) of this range, as stated by Dr Hewson. The majority of infants were either below (46%) or above (42%) this range at 5 minutes of age.

    We agree that neither hyperoxia or hypoxia, even for a few short minutes, is in the best interest of any newborn infant. We concur with Dr Hewson that the current SpO2 recommendations are not evidence-based, especially for sick preterm infants and for either improved short or long-term outcomes. Currently, most clinical practice guidelines recommend the same SpO2 targets for both term and preterm infants (1) and do not take into account, differences in physiological needs. Indeed, Dawson et al showed that even healthy preterm infants needed several minutes more than term infants to achieve SpO2 >90% (2).

    We therefore suggest that caution should be exercised before any specific SpO2 target can be recommended (e.g. 90-95% as suggested by Dr Hewson) without a sufficiently large study that is designed to assess both short and long-term outcomes. Clinical practice has swung dram...

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    Conflict of Interest:
    None declared.
  • Published on: 16 August 2018
    Resuscitation saturation targets

    This study(1) of outcomes of oxygen saturation targeting during delivery room stabilisation or preterm infants, and other data indicating that low saturations are suboptimal for preterm infants requiring resuscitation should now lead to a review of the currently recommended saturation targets. The recommended graduated targets over the first few minutes are not based on evidence of improved outcomes and also add a significant degree of complexity to what is already a challenging resuscitation environment. Complexity is a contributing factor to error in health care(2) .

    The authors incorrectly state that only 12% of preterm infants who were resuscitated with blended oxygen in eight RCTs reached the lower limit of expert committee SpO2 (80%) at 5 min of age. As is made clear elsewhere in the paper, over 50% of newborns reached or exceeded 80% at 5 minutes of age.

    It is possible that the relatively small percentage of infants exactly hitting the saturation target zone (80 – 85%) at 5 minutes is due at least in part to the steep slope of the oxygen dissociation curve at that range of saturation. A relatively modest change in pO2 will lead to a significant change in saturation.

    The physiologically goal should be to avoid hypoxia and avoid hyperoxia. Hypoxia is increasingly likely with pre-ductal saturations below 90%. Hyperoxia is readily avoided by maintaining saturations below 96% for infants in supplemental oxygen(3).

    I suggest a target of 90...

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    Conflict of Interest:
    None declared.