The Objective Use of Pulse Oximetry to Predict Respiratory Support Transition in Preterm Infants: An Observational Pilot Study

Respir Care. 2016 Apr;61(4):416-22. doi: 10.4187/respcare.04102. Epub 2016 Jan 12.


Background: Preterm infants often require some form of respiratory support with supplemental oxygen and are monitored by continuous pulse oximetry (SpO2 ). The study objective was to determine whether the histogram distribution of SpO2 over a 24-h period will predict readiness for weaning respiratory support in preterm infants. We hypothesize that infants with ≥15% of time spent with SpO2 <86% before transitioning from CPAP or high-flow nasal cannula (HFNC) to low-flow nasal cannula, oxyhood, or room air are more likely to fail transitioning.

Methods: The SpO2 histograms were downloaded daily for 31 infants, 24-32 weeks gestational age, before transition from CPAP or HFNC to low-flow nasal cannula, oxyhood, or room air. The SpO2 histogram downloads were continued for each infant for 1 week after transition or when the infant reached 36 weeks postmenstrual age or when SpO2 monitoring was discontinued. Failure was defined as an increase in respiratory support within 72 h of transitioning. We compared the percentage of time for each SpO2 quintile for the 24-h periods before and immediately following CPAP/HFNC transitioning between groups.

Results: Twenty-four subjects transitioned successfully, but 7 subjects failed. Two of 7 subjects (28.6%) who failed transition experienced SpO2 <86% ≥15% of the time pretransition compared with none in the success group (P = .045). The failure group experienced SpO2 <86% 10.7 ± 11.9% of time pre-wean compared with 3.3 ± 4.7% of time in the success group (P = .02). In contrast, infants who were successfully weaned tended to experience a greater percentage of time with SpO2 >95% compared with the failure group, both pre-wean (54.3 ± 36.1% vs. 33 ± 27.7%, P = .16) and post-wean (52 ± 35.4% vs. 27.4 ± 27.7%, P = .10).

Conclusions: These data suggest that pulse oximetry histograms may be useful in assessing CPAP/HFNC support transition readiness.

Keywords: CPAP; HFNC; SpO2; high-flow nasal cannula; histogram; prematurity; pulse oximetry; respiratory support weaning.

Publication types

  • Observational Study

MeSH terms

  • Female
  • Gestational Age
  • Humans
  • Infant, Newborn
  • Infant, Premature / physiology*
  • Male
  • Monitoring, Physiologic / methods
  • Oximetry / methods
  • Oximetry / statistics & numerical data*
  • Oxygen / blood*
  • Pilot Projects
  • Predictive Value of Tests
  • Respiration, Artificial / methods
  • Ventilator Weaning*


  • Oxygen