Pulse oximeter saturation target limits for preterm infants: a survey among European neonatal intensive care units

Abstract

The optimum range of pulse oximeter oxygen saturation (SpO2) for preterm infants remains controversial. Between November 2015 and February 2016, we conducted a web-based survey aimed to investigate the current and former practices on SpO2 targets in European neonatal intensive care units (NICUs). We obtained valid responses from 193 NICUs, treating 8590 newborns ≤28 weeks per year, across 27 countries. Forty different saturation ranges were reported, ranging from 82–93 to 94–99%. The most frequently utilized SpO2 ranges were 90–95% (28%), 88–95% (12%), 90–94% (5%), and 91–95% (5%). A total of 156 NICUs (81%) changed their SpO2 limits over the last 10 years. The most frequently reported former limits were 88–92% (18%), 85–95% (9%), 88–93 (7%), and 85–92% (6%). The NICUs that increased their SpO2 ranges expected to obtain a reduction in mortality. A 54% of the NICUs found the scientific evidence supporting their SpO2 targeting policy strong or very strong.Conclusion: We detected a high degree of heterogeneity in pulse oximeter SpO2 target limits across European NICUs. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.What is Known:• For preterm infants requiring supplemental oxygen, the optimum range of pulse oximeter oxygen saturation (SpO2) to minimize organ damage, without causing hypoxic injury, remains controversial.What is New:• This survey highlights the lack of consensus regarding SpO2target limits for preterm infants among European neonatal intensive care units (NICUs). We detected 40 different SpO2ranges, and even the most frequently reported range (i.e., 90–95%) was used in only 28% of the 193 respondent NICUs.• A total of 156 NICUs (81%) changed their SpO2limits over the last 10 years. The currently used limits are 3 to 5% higher than the former limits, and the most extreme limits, such as lower below 85% or upper above 96%, have almost been abandoned.