Oxygen Saturation Monitoring for the Preterm Infant: The Evidence Basis for Current Practice

Abstract

ABSTRACT:Many of the morbid conditions associated with extreme immaturity are potentiated by an excess of free radicals occurring in infants who developmentally have decreased levels of antioxidants. The optimal oxygen saturation values for the resuscitation, stabilization, and ongoing care of the very low birth weight infant remain largely undefined. We have reviewed the currently available evidence for clinical oxygen use in the newborn period. Until the results of further studies are available, a reasonable approach to resuscitation would include initial resuscitation with 30 -40% oxygen for very preterm infants using targeted SpO 2 values and blended oxygen during the first 10 min. For ongoing management of preterm infants, SpO 2 targets of 85-93% seem to be most appropriate, with alarm limits set within 1 to 2% of these targets with intermittent audits to ensure compliance. There is no strong evidence to support the use of altered limits for the infant who develops early evidence of retinopathy of prematurity. Further prospective studies are required to evaluate the effects of varied oxygen targets on long-term outcome. (Pediatr Res 65: 375-380, 2009) O xygen is essential for adequate cellular functioning and highly specialized systems have developed to maintain a delicate balance during conditions of relatively low to high levels of oxygen availability. However, despite such sophisticated controls prolonged or severe exposures to both excessively low and high oxygen levels may lead to tissue damage. The fetus normally exists in an environment of relatively low oxygen exposure and the mechanisms for managing high oxygen levels are not yet completely developed. Preterm birth alters the natural environmental oxygen exposure at a developmental stage less well adapted to handling oxidative stress. For a more complete review of the physiology of hypoxia and hyperoxia, please refer to the review by Saugstad in this series. The disease processes associated with prematurity frequently necessitate oxygen therapy as a main component of care. The actual acceptable range of oxygen exposure and requirement is not known and may vary by developmental stage. The history of oxygen therapy in neonatology has been described by Silverman as "the albatross of neonatal medicine" (1). The therapeutic index for oxygen use seems to be much narrower than previously realized, and we have yet to define the optimal oxygen exposure for the most premature infants.Currently available information suggests that many of the morbid conditions associated with extreme immaturity are potentiated by an excess of free radicals occurring in infants who developmentally have decreased levels of antioxidants. During hypoxia, metabolic alterations prime hypoxic cells to produce free oxygen radicals when subsequently exposed to oxygen. Such reperfusion injury, in addition to increasing the production of free oxygen radicals, is associated with other metabolic changes, which may produce long lasting harmful effects. Silvers et al. (2) reported that low ...

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