Abstract
During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range.Conclusion: The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit. What is Known: • The use of oxygen in preterm infants is vital, but the optimal strategy remains controversial. • Targeting SpO 2 during oxygen therapy in preterm infants has been shown to reduce mortality and morbidity. What is New:• Review of the literature showed that the compliance in targeting SpO 2 and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting, decreasing nurse/patient ratio and automated oxygen therapy could increase compliance.
Highlights
Supplemental oxygen is often administered to preterm infants for hypoxemic episodes during respiratory distress orEur J Pediatr (2015) 174:1561–1572 apnoeas
Review of the literature showed that the compliance in targeting SpO2 and alarm settings is low
It is important to prevent hypoxaemia (defined as a decrease in arterial blood saturation (SpO2) of ≤80 % for ≥10 s), as frequent episodes could lead to an increased risk of morbidities, including retinopathy of prematurity (ROP), impaired growth, longer term cardio-respiratory instability and adverse neurodevelopmental outcome [12, 15, 30]
Summary
Supplemental oxygen is often administered to preterm infants for hypoxemic episodes during respiratory distress orEur J Pediatr (2015) 174:1561–1572 apnoeas. Maintaining the SpO2 within this range can be challenging, and compliance—defined as the nurse’s behaviour that follows the clinical guidelines—[13] is influenced by several factors [40] This compliance is important, as it can largely influence the effect of a certain SpO2 target range. The optimal range of SpO2 for preterm infants remains undefined, but recent trials have shown that aiming for 91–95 % has decreased mortality but increased incidence of ROP [36]. In these trials, oxygen was titrated manually, which caused a large overlap in the distribution of SpO2 between the two groups and may have decreased the observed differences in outcome
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