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

Pratik Parikh; Robert D White; Veeral N Tolia; Brent Reyburn; Charleta Guillory; Kaashif A Ahmad

doi:10.1055/s-0044-1780523

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

Am J Perinatol. 2024 Feb 19. doi: 10.1055/s-0044-1780523. Online ahead of print.

Authors

Pratik Parikh¹, Robert D White², Veeral N Tolia^{3

4}, Brent Reyburn⁵, Charleta Guillory⁶, Kaashif A Ahmad^{3

7}

Affiliations

¹ Department of Pediatrics, Baylor College of Medicine, Christus Children Hospital, San Antonio, Texas.
² Regional Newborn Program, Beacon Children's Hospital, South Bend, Indiana.
³ Pediatrix Center for Research, Education, Quality and Safety, Sunrise, Florida.
⁴ Department of Pediatrics, Baylor University Medical Center, Dallas, Texas.
⁵ Department of Pediatrics, Baptist Children's Hospital at North Central, San Antonio, Texas.
⁶ Department of Pediatrics, Baylor College of Medicine, Neonatal-Perinatal Public Health Program, Texas Children's Hospital, Houston, Texas.
⁷ Department of Neonatology, The Woman's Hospital of Texas, Houston, Texas.

PMID: 38373706
DOI: 10.1055/s-0044-1780523

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..