Oxygen saturation targeting—an illusion

Abstract

The optimal oxygen saturation for very preterm infants has been extensively discussed, primarily because of the potential for competing outcomes. A lower saturation range target can decrease retinopathy of prematurity, but may increase mortality, and a higher target range can increase the severity or frequency of bronchopulmonary dysplasia. Which target range is optimal for neurodevelopment remains of conjecture. Three trials reported almost 5000 randomized infants in aggregate, and each trial was interpreted by the authors somewhat differently (NEJM 2013;368:294-104; NEJM 2010;362:1959-69; and JAMA 2013;309:2111-20). The neurodevelopmental outcomes should be available soon, which will then allow for a meta-analysis of the trials. However, a consensus of all investigators is that it is very difficult to keep the oxygen saturation in the desired target range. That difficulty is highlighted in this issue of The Journal in a report by Lim et al, who evaluated oxygen saturation targeting at 88% to 92% and with alarms set at 85% to 94% when oxygen was used for infants receiving continuous positive airway pressure. The authors found that these infants spent 31% of the time in the target range despite a major nursing effort. The infants were outside of the wider alarm limits almost 50% of the time. The neonatal community will need to use the information from the 3 large oxygen targeting trials and from reports such as this one by Lim et al to develop practical goals for oxygen targeting. Article page 730▶ Oxygen Saturation Targeting in Preterm Infants Receiving Continuous Positive Airway PressureThe Journal of PediatricsVol. 164Issue 4PreviewThe precision of oxygen saturation (SpO2) targeting in preterm infants on continuous positive airway pressure (CPAP) is incompletely characterized. We therefore evaluated SpO2 targeting in infants solely receiving CPAP, aiming to describe their SpO2 profile, to document the frequency of prolonged hyperoxia and hypoxia episodes and of fraction of inspired oxygen (FiO2) adjustments, and to explore the relationships with neonatal intensive care unit operational factors. Full-Text PDF