Oxygen Saturation in the Newborn and the Importance of Avoiding Hyperoxia-Induced Damage

Abstract

Dr Sola has disclosed he works part-time for Masimo Corp. as vice president, medical affairs, neonatology. This commentary does contain a discussion of an unapproved/ investigative use of a commercial product/ device. Educational GapThere is a need for education about judicious use of oxygen supplementation and potential damaging effects of hyperoxemia. AbstractWhen a newborn has suspected or confirmed hypoxemia, clinical measures for evaluation and treatment are started without delay, which is appropriate. Oxygen is among the most widely used drugs in neonatal care, but the adverse effects of excess oxygen administration, hyperoxemia, and hyperoxia are not addressed in a similar way. This review describes issues of clinical significance related to oxygenation and saturation targets with the main objective of decreasing morbidities associated with excess oxygen use.Objectives After completing this article, readers should be able to:1. Improve understanding of oxygenation and saturation. 2. Advance knowledge for considering excess oxygen as a neonatal health hazard. 3. Increase attentiveness on issues related to targeting of oxygen saturation. 4. Collaborate to improve clinical practice and outcomes.

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

“…However, for preterm infants requiring supplemental oxygen, the optimum range of SpO 2 to minimize organ damage, without causing hypoxic injury, remains controversial [9, 10]. Between 2005 and 2007, five randomized trials, known collectively as the Neonatal Oxygen Prospective Meta-analysis (NeOProM) collaboration, were designed to compare the effects of a lower SpO 2 target range (85 to 89%) vs. a higher target range (91 to 95%) in preterm infants (<28 weeks) [1, 11].…”

Reliability and Validity of a Smartphone-Paired Pulse Oximeter for Screening of Critical Congenital Heart Defects in Newborns

“…Unfortunately, we can only speculate on this point because we did not perform repeated measurements with any of the two devices in order to estimate the inherent bias in our setting. Nevertheless, it should be noted that current industry data report neonatal-based pulse oximetry algorithms to have a precision (SD of the bias) that can be as low as 2% on some monitors but as high as 5% on others [18]. Interestingly, the SD of the bias that we observed between the Radical-7 and the iSpO 2 -Rx was less than 2%.…”

“…Moreover, the iSpO 2 -Rx provided reliable measurements of saturations below 95% in a group of NICU patients. We did not observe any systematic bias and the differences between the two pulse oximeters can be attributed to the inherent bias that all saturation monitors have when they function according to their specifications [18]. Unfortunately, we can only speculate on this point because we did not perform repeated measurements with any of the two devices in order to estimate the inherent bias in our setting.…”

“…The iSpO 2 -Rx is a CE-marked, dual-wave pulse oximeter equipped with signal extraction technology (SET™) that, according to the manufacturer, provides reliable readings even in low-perfusion states and with patient movements [18,19]. The companion software application (app) provides the oxygen saturation, the pulse rate, and the perfusion index [17,19].…”

"Oxygen therapy in neonates". An unresolved problem

“…El O es un elemento necesario para la vida, su uso 2 muchas veces termina siendo iatrogénico ya que (18) muchos de los RN son expuestos a la hiperoxia , cual es la saturación de oxígeno (SpO ) óptima para 2 el tratamiento de RN, ésta aún no ha podido ser determinada. Sin embargo, numerosos y estudios clínicos randomizados, meta-análisis y comentarios publicados recientemente han añadido información (19) valiosa y han permitido el discernimiento , sobretodo de lo que debería evitarse durante la oxigenoterapia.…”