Observing the resuscitation of very preterm infants: are we able to follow the oxygen saturation targets?

Tom G Goos; Denise Rook; Anne C van der Eijk; Andre A Kroon; Gerhard Pichler; Berndt Urlesberger; Jenny Dankelman; Irwin K M Reiss

doi:10.1016/j.resuscitation.2013.01.025

Observing the resuscitation of very preterm infants: are we able to follow the oxygen saturation targets?

Resuscitation. 2013 Aug;84(8):1108-13. doi: 10.1016/j.resuscitation.2013.01.025. Epub 2013 Jan 29.

Authors

Tom G Goos¹, Denise Rook, Anne C van der Eijk, Andre A Kroon, Gerhard Pichler, Berndt Urlesberger, Jenny Dankelman, Irwin K M Reiss

Affiliation

¹ Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology, Delft, The Netherlands. T.Goos@erasmusmc.nl

PMID: 23376585
DOI: 10.1016/j.resuscitation.2013.01.025

Abstract

Background: Since 2010, the European Resuscitation Council (ERC) guidelines advise oxygen saturation (SpO2) targets for the first 10 min of resuscitation after birth. Unfortunately, the control of SpO2 in newborn infants is difficult.

Aim: To determine to what extent SpO2 levels match the ERC targets during the resuscitation of very preterm infants, and how well the SpO2 is kept within the high and low limits until the infants are transported to the NICU.

Methods: In a single-centre observational study, the SpO2 and fraction of inspired oxygen (FiO2) were collected during the resuscitation of very preterm infants with a gestational age (GA)≤ 30 weeks.

Results: A total of 78 infants were included [median (IQR): GA 27(4)/7 (26-28(6)/7) weeks, birth weight 945 g (780-1140)]. During the initial 10 min after birth, large variations in SpO2 were observed with deviations above the target [median (IQR)] of 4.4% SpO2 (1.4-6.5), and below the target of 8.2% SpO2 (2.8-16.0). After the first 10 min, the SpO2 levels were respectively above and below the limit for 11% (0-27) and 8% (0-23) of the time.

Conclusion: During the resuscitation of very preterm infants, large deviations of the SpO2 from the ERC targets are observed. During the first minutes of resuscitation the deviations were likely caused by an inability to control the SpO2, whereas later deviations were due to weaning, pauses in respiratory support (i.e. intubation) and over exposure to oxygen. Changing the SpO2 targets to a target range that depicts the acceptable deviation might be helpful in providing better respiratory support.

Keywords: AHA; ARC; American Heart Association; Australian Resuscitation Council; CS; ERC; European Resuscitation Council; FiO(2); GA; IQR; Infant; NICU; NZRC; Neonate; New Zealand Resuscitation Council; Oxygen; PEEP; PIP; Preterm; Resuscitation; Saturation; SpO(2); beats per minute; bpm; caesarean section; fraction of inspired oxygen; gestational age; inter quartile range; neonatal intensive care unit; peak inspiratory pressure; positive end expiratory pressure; pulse oximetry oxygen saturation.

Publication types

Observational Study

MeSH terms

Female
Gestational Age
Humans
Infant, Extremely Premature / blood*
Infant, Newborn
Infant, Premature, Diseases* / blood
Infant, Premature, Diseases* / diagnosis
Infant, Premature, Diseases* / epidemiology
Infant, Premature, Diseases* / therapy
Male
Monitoring, Physiologic / methods
Netherlands / epidemiology
Outcome and Process Assessment, Health Care
Oximetry* / methods
Oximetry* / standards
Oxygen / blood*
Resuscitation* / methods
Resuscitation* / statistics & numerical data
Time-to-Treatment

Substances

Oxygen