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Am J Perinatol 2024; 41(12): 1728-1735
DOI: 10.1055/s-0044-1780523
Original Article

Variability in Practice and Implementation of Oxygen Target Saturation Policies in United States' Neonatal Intensive Care Units

Pratik Parikh
1   Department of Pediatrics, Baylor College of Medicine, Christus Children Hospital, San Antonio, Texas
,
Robert D. White
2   Regional Newborn Program, Beacon Children's Hospital, South Bend, Indiana
,
Veeral N. Tolia
3   Pediatrix Center for Research, Education, Quality and Safety, Sunrise, Florida
4   Department of Pediatrics, Baylor University Medical Center, Dallas, Texas
,
Brent Reyburn
5   Department of Pediatrics, Baptist Children’s Hospital at North Central, San Antonio, Texas
,
Charleta Guillory
6   Department of Pediatrics, Baylor College of Medicine, Neonatal-Perinatal Public Health Program, Texas Children's Hospital, Houston, Texas
,
Kaashif A. Ahmad
3   Pediatrix Center for Research, Education, Quality and Safety, Sunrise, Florida
7   Department of Neonatology, The Woman's Hospital of Texas, Houston, Texas
› Author Affiliations Funding None.
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Abstract

Objective This study aimed to describe target oxygen saturation (SpO2) ranges used for premature infants in United States' neonatal intensive care units (NICUs) and to describe if these target SpO2 ranges have changed in recent years.

Study Design A 29-question survey focused on target SpO2 practices and policies was distributed via the NICU medical directors listservs for the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine and Pediatrix Medical Group between August and October of 2021. Results were collected via Research Electronic Data Capture (REDCap).

Results We received responses representing 170 unique, levels 2, 3, and 4 NICUs from 36 states. Most NICUs (130, 78%) have recently changed their SpO2 targets in response to target SpO2 clinical trials. Over time, the most commonly reported target SpO2 range has shifted from 88–92% to 90–95. Of NICUs that changed limits, the most common lower SpO2 limits increased from 88 to 90% and the upper SpO2 limits changed from 92 to 95%. The interquartile range for lower SpO2 limit shifted from 85–88% to 88–90% and the IQR for upper SpO2 limit decreased from 92–95 to 94–95%. Most NICUs had designated conditions that would allow for deviations from standard target SpO2 ranges. These most commonly include pulmonary hypertension (152, 95%), severe bronchopulmonary dysplasia (81, 51%), and retinopathy of prematurity (51, 32%).

Conclusion Oxygen saturation limits have changed over time with an overall increase in targeted SpO2. However, there remains considerable interunit variation in SpO2 policies. There is a need to achieve consensus to optimize clinical outcomes.

Key Points

  • What are the SpO2 ranges in United States' NICUs?

  • There is a shift in SpO2 ranges for preterm infants in NICUs across United States.

  • Variability still persists in SpO2 ranges for preterm infants in United States' NICUs.

Keywords

oxygen saturation - oxygen target saturation ranges - alarm limits - retinopathy of prematurity

Ethical Approval

This study was approved by the Methodist Healthcare Institutional Review Board (San Antonio, TX).


Availability of Data and Material

The data that support the findings of this study are not publicly available due to concern of identifying NICUs who responded in the survey but are available from the corresponding author (P.P.).


Authors' Contributions

P.P. was responsible for conceptualization, methodology, investigation data curation, formal analysis, resources, writing initial manuscript and editing manuscript. K.A.A. was responsible for conceptualization, methodology, investigation, supervision, formal analysis, reviewing and editing the manuscript. V.N.T., R.D.W., and C.G. were responsible for conceptualization, supervision, reviewing and editing the manuscript. B.R. was responsible for conceptualization and reviewing and editing the manuscript.


Supplementary Material



Publication History

Received: 18 October 2023

Accepted: 23 January 2024

Article published online:
19 February 2024

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