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Oxygen targeting in preterm infants: a physiological interpretation

Journal of Perinatology volume 35, pages 8–15 (2015)Cite this article

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Abstract

Randomized controlled trials evaluating low-target oxygen saturation (SpO2:85% to 89%) vs high-target SpO2 (91% to 95%) have shown variable results regarding mortality and morbidity in extremely preterm infants. Because of the variation inherent to the accuracy of pulse oximeters, the unspecified location of probe placement, the intrinsic relationship between SpO2 and arterial oxygen saturation (SaO2) and between SaO2 and partial pressure of oxygen (PaO2) (differences in oxygen dissociation curves for fetal and adult hemoglobin), the two comparison groups could have been more similar than dissimilar. The SpO2 values were in the target range for a shorter period of time than intended due to practical and methodological constraints. So the studies did not truly compare ‘target SpO2 ranges’. In spite of this overlap, some of the studies did find signficant differences in mortality prior to discharge, necrotizing enterocolitis and severe retinopathy of prematurity. These differences could potentially be secondary to time spent beyond the target range (SpO2 <85 or >95%) and could be avoided with an intermediate but wider target SpO2 range (87% to 93%). In conclusion, significant uncertainty persists about the desired target range of SpO2 in extremely preterm infants. Further studies should focus on studying newer methods of assessing oxygenation and strategies to limit hypoxemia (<85% SpO2) and hyperoxemia (>95% SpO2).

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Acknowledgements

This work was supported by a grant 5 R01 HD072929 (Optimal oxygenation in neonatal lung injury) to SL.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Women and Children’s Hospital of Buffalo and University at Buffalo, Buffalo, NY, USA

    S Lakshminrusimha & B Mathew

  2. Division of Cardiology, Department of Medicine, Veterans Affairs Medical Center and University at Buffalo, Buffalo, NY, USA

    V Manja

  3. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Geisel School of Medicine, Hanover, NH, USA

    G K Suresh

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  1. S Lakshminrusimha
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  4. G K Suresh
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Correspondence to S Lakshminrusimha.

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Lakshminrusimha, S., Manja, V., Mathew, B. et al. Oxygen targeting in preterm infants: a physiological interpretation. J Perinatol 35, 8–15 (2015). https://doi.org/10.1038/jp.2014.199

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