Adherence to oxygen saturation targets increased in preterm infants when a higher target range and tighter alarm limits were introduced

Abstract

Aim: European consensus guidelines published in May 2013 recommended a target peripheral capillary oxygen saturation (SpO₂ ) range of 90-95% for preterm infants. These were incorporated into guidelines at the Karolinska University Hospital, Sweden, in November 2013. This study compared clinical practice before and after those local guidelines.

Methods: We included infants who were born between 23 + 0 and 30 + 6 weeks from January 1, 2013 to December, 31 2015 and received intensive care in two Karolinska units. The lower saturation target of 88-92% and alarm limits of 85-95% used before November 2013 were compared to the new higher saturation target of 90-95% and alarm limits of 89-96%.

Results: Data from 399 infants were analysed. The mean SpO₂ was 92.4% with the higher target (n = 301) and 91.1% with the lower target (n = 98). Using the higher instead of lower target meant that the SpO₂ was within the prescribed target range more frequently (51% versus 30%) and the proportion of time with SpO₂ >95% was increased by 9% (95% confidence interval 7-11%, p < 0.001).

Conclusion: The higher saturation target and tighter alarm limits led to higher mean oxygen saturation, increased adherence to the target and increased time with hyperoxaemia.

Keywords: Oxygenation; Preterm infants; Pulse oximetry; Retinopathy of prematurity; Saturation target.