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Am J Perinatol
DOI: 10.1055/a-2771-5370
Original Article

Assessing Oxygenation Instability in Premature Infants <1,500 Grams: Nursing Charts versus SpO2 Histograms—Is Two Better Than One?

Authors

  • Viktoria Leikin Zach   ‡

    1   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
    2   Department of Neonatology, Rambam Health Care Campus, Haifa, Israel

  • Arieh Riskin   ‡

    1   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
    3   Department of Neonatology, Bnai Zion Medical Center, Haifa, Israel

  • Irina Raizberg

    2   Department of Neonatology, Rambam Health Care Campus, Haifa, Israel

  • Ori Hochwald

    1   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
    2   Department of Neonatology, Rambam Health Care Campus, Haifa, Israel

  • Amir Kugelman

    1   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
    2   Department of Neonatology, Rambam Health Care Campus, Haifa, Israel

  • Liron Borenstein-Levin 

    1   Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
    2   Department of Neonatology, Rambam Health Care Campus, Haifa, Israel
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Abstract

Objective

Despite availability of advanced monitoring tools, most neonatologists still primarily rely on nursing documentation of desaturation and bradycardia events to assess the respiratory status of very low birth weight (VLBW) premature infants. We aimed to compare oxygenation instability as recorded in nursing charts versus SpO2 histograms in VLBW infants during their first weeks of life.

Study Design

An observational study including VLBW premature infants who required respiratory support on day 1 of life. We recorded the daily number of desaturation events <90% from nursing charts and the cumulative duration of SpO2 <90% from 24 hours SpO2 histograms. Data were collected from birth until respiratory support was discontinued.

Results

Data from 1,749 chart days of 77 VLBW infants (mean ± SD birth weight 1,040 ± 243 g; gestational age: 28.5 ± 2.1weeks) were analyzed. A strong Pearson correlation was found between the number of desaturation events and total time in SpO2 <90% (r = 0.8). However, similar event counts often reflected different hypoxemia burden. Eight or more daily desaturation events predict an unstable SpO2 histogram (sensitivity: 90.3%, specificity: 76.1%).

Conclusion

Nursing charts and SpO2 histograms strongly correlate but offer unique insights—charts capture the frequency and distribution of desaturation events, while histograms quantify overall hypoxemic exposure. Used together, they provide a more comprehensive assessment of respiratory status in VLBW infants.

Key Points

  • Oxygenation instability is common among VLBW premature infants.

  • We compared oxygenation instability documentation in the NICU by nursing charts versus SpO2 histograms.

  • Strong Pearson correlation was found between documented desaturation events and time with SpO2 <90%.

  • However, for a given number of desaturation events, the time in SpO2 <90% varied significantly.

  • Combining charts and SpO2 histograms gives a more complete respiratory assessment in VLBW infants.

Keywords

hypoxemic event - neonate - NICU - oxygenation instability - premature infants

‡ These authors contributed equally to this article.




Publication History

Received: 10 September 2025

Accepted: 11 December 2025

Article published online:
31 December 2025

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