Achieving Targeted Pulse Oximetry Values in Preterm Infants in the Delivery Room

• Published in: The Journal of pediatrics Vol. 163; no. 2; pp. 412 - 415
• Main Authors: Gandhi, Bheru, MD, Rich, Wade, RRT, Finer, Neil, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2013; Mosby, Inc
• Subjects: birth weight; children; Delivery Rooms; gestational age; Humans; Infant, Newborn; Infant, Premature - physiology; neonates; Oximetry - standards; Oximetry - statistics & numerical data; oxygen; Pediatrics; Prospective Studies; teams; Time Factors; Fraction of inspired oxygen; SpO 2; Room-Air versus Oxygen Administration for Resuscitation of Preterm Infants; FiO 2; ROAR; GA; NRP; TOTS; Gestational age; Oxygen saturation; Neonatal Resuscitation Program; Transitional Oxygen Targeting System; FiO2; SpO2; SpO; FiO
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.01.010

Objective To determine whether resuscitation teams can better maintain newborn transitional oxygen saturation (SpO2 ) values within a prespecified target range using a graphical display of the targets and real-time SpO2 data compared with using only numerical oximeter values. Study design Preterm neonates were enrolled in this prospective cohort evaluation of a change in practice. The Transitional Oxygen Targeting System (TOTS) plots real-time SpO2 values in relation to 10th and 50th percentile SpO2 curves, which provides a visual target. After introduction of the TOTS, the resuscitation team adjusted the fraction of inspired oxygen to maintain the SpO2 within the target range, and before its use neonates were resuscitated in attempt to target normal transitional SpO2 values without using the TOTS monitor. Duration of time within 10th-50th percentile values was compared between 2 cohorts, children evaluated with the TOTS and those not evaluated with the TOTS (controls). Results A total of 40 infants were enrolled, including 20 prospectively evaluated with the TOTS and 20 controls. Mean gestational age, birth weight, total resuscitation time, duration of supplemental oxygen administration, changes in oxygen concentration, and respiratory support provided were similar in the 2 groups. The TOTS cohort spent 52% of time within the target range; the control cohort, 37% ( P = .03). Conclusion SpO2 values were maintained within a specified target range for significantly longer in preterm neonates resuscitated using the TOTS display compared with those resuscitated without TOTS.