Browse > Article
http://dx.doi.org/10.5385/jksn.2011.18.2.320

The Optimal Pulse Oxygen Saturation in Very Low Birth Weight or Very Preterm Infants  

You, Sun-Young (Department of Pediatrics, Graduate School of Medicine, Chungnam National University)
Kang, Hye-Jin (Department of Pediatrics, Graduate School of Medicine, Chungnam National University)
Kim, Min-Jung (Department of Pediatrics, Chungnam National University Hospital)
Chang, Mea-Young (Department of Pediatrics, Graduate School of Medicine, Chungnam National University)
Publication Information
Neonatal Medicine / v.18, no.2, 2011 , pp. 320-327 More about this Journal
Abstract
Purpose: To determine the effect of changing practice guidelines designed to avoid hyperoxia or hypoxia in very low birth weight or very preterm infants. Methods: We analyzed a database of <1,500 g birth weight or <32 weeks of gestation infants who were born and admitted to the neonatal intensive care unit of Chungnam National University Hospital from January 2007 to July 2010. First, we defined the relationship between arterial partial pressure of oxygen ($PaO_2$) and pulse oxygen saturation ($SpO_2$). When we evaluated 96 pairs of $PaO_2$ and $SpO_2$ measurements, oxygen saturation was 90-94% at a $PaO_2$ of 43-79 mmHg on the oxyhemoglobin dissociation curve, according to pulse oximetry. Based on this observation, a change in practice was instituted in August 2008 with the objective of avoiding hypoxia and hyperoxia in preterm infants with targeting a $SpO_2$ 90-94% (period II). Before the change in practice, high alarms for $SpO_2$ were set at 100% and low alarms at 95% (period I). Results: Sixty-eight infants the met enrollment criteria and 38 (56%) were born during period II, after the change in $SpO_2$ targets. Demographic characteristics, except gender, were similar between the infants born in both periods. After correcting for the effect of confounding factors, the rates for mortality, severe retinopathy of prematurity, and IVH attended to be lower than those for infants in period II. No difference in the rate of patent ductus arteriosus needed to treat was observed. Conclusion: A change in the practice guidelines aimed at avoiding low oxygen saturation and hyperoxia did not increase neonatal complication rates and showed promising results, suggesting decreased mortality and improvements in short term morbidity. It is still unclear what range of oxygen saturation is appropriate for very preterm infants but the more careful saturation targeting guideline should be considered to prevent hypoxemic events and hyperoxia.
Keywords
Premature infant; Oxygen; Blood gas analysis; Oximetry; Practice guideline; Mortality; Morbidity;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Kinsey VE, Arnold HJ, Kalina RE, Stern L, Stahlman M, Odell G, et al. PaO2 levels and retrolental fibroplasia: a report of the cooperative study. Pediatrics 1977;60:655-68.
2 Flynn JT, Bancalari E, Snyder ES, Goldberg RN, Feuer W, Cassady J, et al. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity. N Engl J Med 1992;326:1050-4.   DOI   ScienceOn
3 Silvers KM, Gibson AT, Russell JM, Powers HJ. Antioxidant activity, packed cell transfusions, and outcome in premature infants. Arch Dis Child Fetal Neonatal Ed 1998;78:F214-9.   DOI
4 Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9.   DOI   ScienceOn
5 Haynes RL, Folkerth RD, Keefe RJ, Sung I, Swzeda LI, Rosenberg PA, et al. Nitrosative and oxidative injury to premyelinating oligodendrocytes in periventricular leukomalacia. J Neuropathol Exp Neurol 2003;62:441-50.
6 Collins MP, Lorenz JM, Jetton JR, Paneth N. Hypocapnia and other ventilation-related risk factors for cerebral palsy in low birth weight infants. Pediatr Res 2001;50:712-9.   DOI   ScienceOn
7 Wright KW, Sami D, Thompson L, Ramanathan R, Joseph R, Farzavandi S. A physiologic reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity. Trans Am Ophthalmol Soc 2006;104:78-84.
8 Chow LC, Wright KW, Sola A; CSMC Oxygen Administration Study Group. Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? Pediatrics 2003;111:339-45.   DOI   ScienceOn
9 Deulofeut R, Critz A, Adams-Chapman I, Sola A. Avoiding hyperoxia in infants < or = 1250 g is associated with improved shortand long-term outcomes. J Perinatol 2006;26:700-5.   DOI   ScienceOn
10 Tin W, Milligan DW, Pennefather P, Hey E. Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001;84:F106-10.   DOI
11 Noori S, Patel D, Friedlich P, Siassi B, Seri I, Ramanathan R. Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants. J Perinatol 2009;29:553-7.   DOI   ScienceOn
12 Tokuhiro Y, Yoshida T, Nakabayashi Y, Nakauchi S, Nakagawa Y, Kihara M, et al. Reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity in infants of <33 weeks gestation. Pediatr Int 2009;51:804-6.   DOI   ScienceOn
13 Tarnow-Mordi WO, Darlow B, Doyle L. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med 2010;363: 1285-6.   DOI   ScienceOn
14 SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Carlo WA, Finer NN, Walsh MC, Rich W, Gantz MG, et al. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med 2010;362:1959-69.   DOI   ScienceOn
15 Laptook AR, Salhab W, Allen J, Saha S, Walsh M. Pulse oximetry in very low birth weight infants: can oxygen saturation be maintained in the desired range? J Perinatol 2006;26:337-41.   DOI   ScienceOn
16 Lee HJ, Choi JH, Min SJ, Kim DH, Kim HS. Comparison of the clinical performance between two pulse oximeters in NICU: Nellcor N-$595^{(R)}$ versus Masimo $SET^{(R)}$. J Korean Soc Neonatol 2010;17:245-9.   DOI
17 Castillo A, Sola A, Baquero H, Neira F, Alvis R, Deulofeut R, et al. Pulse oxygen saturation levels and arterial oxygen tension values in newborns receiving oxygen therapy in the neonatal intensive care unit: is 85% to 93% an acceptable range? Pediatrics 2008;121:882-9.   DOI   ScienceOn
18 Finer N, Leone T. Oxygen saturation monitoring for the preterm infant: the evidence basis for current practice. Pediatr Res 2009;65: 375-80.   DOI   ScienceOn
19 Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005;116:1353-60.   DOI   ScienceOn
20 An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity. Arch Ophthalmol 1984;102:1130-4.   DOI   ScienceOn
21 Volpe JJ. Neurology of the newborn. 5th ed. Philadelphia : Saunders, 2008:541.
22 Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978;187:1-7.   DOI   ScienceOn
23 Saugstad OD. Bronchopulmonary dysplasia-oxidative stress and antioxidants. Semin Neonatol 2003;8:39-49.   DOI   ScienceOn
24 Wilson JL, Long SB, Howard PJ. Respiration of premature infants: response to variations of oxygen and to increased carbon dioxide in inspired air. Am J Dis Child 1942;63:1080-5.
25 Campbell K. Intensive oxygen therapy as a possible cause of retrolental fibroplasia; a clinical approach. Med J Aust 1951;2:48-50.
26 Gressens P, Rogido M, Paindaveine B, Sola A. The impact of neonatal intensive care practices on the developing brain. J Pediatr 2002;140: 646-53.   DOI   ScienceOn
27 Chandel NS, Budinger GR. The cellular basis for diverse responses to oxygen. Free Radic Biol Med 2007;42:165-74.   DOI   ScienceOn
28 Chang HY, Park EH, Oh CH, Park MS, Namgung R, Park KI, et al. Changes in pulmonary interleukin-6 and pulmonary pathology in neonatal mice after exposure to hyperoxia and ascorbate treatment. J Korean Soc Neonatol 2001;8:103-9.
29 Smith LE. Pathogenesis of retinopathy of prematurity. Semin Neonatol 2003;8:469-73.   DOI   ScienceOn
30 Gyllensten L. Influence of oxygen exposure on the differentiation of the cerebral cortex of growing mice. Acta Morphol Neerl Scand 1959;2:311-30.
31 Tin W. Optimal oxygen saturation for preterm babies. Do we really know? Biol Neonate 2004;85:319-25.   DOI   ScienceOn
32 Chen ML, Guo L, Smith LE, Dammann CE, Dammann O. High or low oxygen saturation and severe retinopathy of prematurity: a meta-analysis. Pediatrics 2010;125:e1483-92.   DOI
33 Saugstad OD, Aune D. In search of the optimal oxygen saturation for extremely low birth weight infants: a systematic review and metaanalysis. Neonatology 2011;100:1-8.   DOI   ScienceOn
34 Askie LM, Henderson-Smart DJ, Ko H. Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. Cochrane Database Syst Rev 2009;(1):CD001077.
35 Bunn HF, Poyton RO. Oxygen sensing and molecular adaptation to hypoxia. Physiol Rev 1996;76:839-85.
36 Warner BB, Stuart LA, Papes RA, Wispé JR. Functional and pathological effects of prolonged hyperoxia in neonatal mice. Am J Physiol 1998;275:L110-7.
37 American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 5th ed. Chicago : American Academy of Pediatrics, 2002:246.
38 Salyer JW. Neonatal and pediatric pulse oximetry. Respir Care 2003;48:386-96.
39 Hagadorn JI, Furey AM, Nghiem TH, Schmid CH, Phelps DL, Pillers DA, et al. Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: the AVIOx study. Pediatrics 2006;118:1574-82.   DOI   ScienceOn
40 Claure N, Bancalari E, D'Ugard C, Nelin L, Stein M, Ramanathan R, et al. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics 2011;127:e76-83.   DOI