Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest

Curr Opin Pediatr. 2017 Apr;29(2):153-158. doi: 10.1097/MOP.0000000000000458.


Purpose of review: A collaboration of comparative effectiveness research trials of pulse oximeter saturation (SpO2) targeting in extremely low-gestational-age neonates have begun to report their aggregate results. We examine the results of those trials, collectively referred to as the Neonatal Oxygenation Prospective Meta-analysis or NeOProM. We also discuss the uncertainties that remain and the clinical challenges that lie ahead.

Recent findings: The primary outcome from NeOProM was a composite of death or disability at 18-24 months corrected age. In 2016 the last of these reports was published. Although there were no differences in the primary outcome overall, analyses of secondary outcomes and data subsets following a pulse oximeter revision show significant treatment differences between targeting a lower compared with a higher SpO2.

Summary: NeOProM represents the largest collaborative clinical research study of SpO2 targets in extremely low-gestational-age neonates. Although aggregate results give us some insight into the feasibility and efficacy of SpO2 targeting in this population, many questions remain. A patient-level analysis, tracking individual outcomes based on actual SpO2 experienced, may shed some light on these questions. However, finding a single optimal SpO2 range seems unlikely.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Female
  • Follow-Up Studies
  • Gestational Age
  • Humans
  • Infant, Extremely Premature*
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Intensive Care, Neonatal / methods*
  • Male
  • Monitoring, Physiologic / methods
  • Oximetry / methods*
  • Oxygen / blood*
  • Oxygen Consumption
  • Oxygen Inhalation Therapy / adverse effects
  • Oxygen Inhalation Therapy / methods*
  • Pregnancy
  • Prospective Studies
  • Risk Assessment
  • Treatment Outcome


  • Oxygen