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Oxygen monitoring: too low or too high? National survey of oxygen saturation monitoring policies and the audit on the effect of change of policy in a single Neonatal Intensive Care Unit (NICU)

Presented at the Neonatal Society 2002 Summer Meeting (programme).

Lacamp C, Walker S (introduced by Dr. W. Tin)

Department of Paediatrics, The James Cook University Hospital, Middlesbrough, TS4 3BW, UK

Background: Pulse oximetry has been widely used for monitoring saturation in babies needing supplemental oxygen, but uncertainty remains as to most appropriate target range in the very preterm baby. The prospective observational study published recently concluded that the attempts to keep oxygen saturation at so called "physiological" level may do more harm than good in babies of less than 28 weeks gestation (1).

Aim: 1. To find out how much oxygen saturation monitoring policies vary amongst NICUs in the United Kingdom, and 2. To look at the effect of change in policy from "high" to "low" saturation limits in one NICU.

Methods: 1. A telephone questionnaire survey of all NICUs with 3 or more intensive care cots, caring for babies of under 28 weeks gestation in the U.K. using NICU directory. 2. A review of the records of all babies in one unit, who survived infancy after delivery between 25 and 27 weeks gestation in 1995 and 96 (high limits) and 1998 to 2000 (low limits).

Results: 1. Out of 104 NICUs surveyed, a response was obtained from 100 units (response rate 96%). Forty two of 100 NICUs set their lower alarm limit for a saturation at 90% or higher, and 38 units set their upper limit at 98% or higher. Ninety percent set the lower limit between 85 and 93% and the upper limit between 93 and 99%. Only 2 units let saturation vary 15% or more; 19 units let it vary 6% or less. 2. There were 52 babies cared for with high oxygen saturation limits (88%-98%), and 67 with low limits (75%-93%). Birth weight, gender and antenatal steroid uptakes were comparable in the two groups. There was no difference in one year survival (71% in 1995-96 v 79% in 1998-2000), but babies cared for using a restricted oxygen policy required only half as much ventilatory support (median 5 v 13 days, mean 9.8 v 16.4 days).

Conclusions: There is no consensus in the UK over how to monitor oxygen saturation in the very preterm baby. Accepting a saturation limit of 75-93% is associated with much shorter period of ventilatory support.

1. Tin W, Milligan DWA, Pennefather PM, Hey E. Arch Dis Child 2001; 84: F106-110

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