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Conference Highlights from Hot Topics in Neonatology Washington, DC; Dec 9-11, 2001
Pulse Oximeter Alarm Settings
Oxygen Monitoring: Too Low or Too High? Dr. Win Tin, Middlesbrough, UK.
The outcomes of 295 babies surviving after delivery at < 28 weeks EGA were reviewed with regard to target oxygen saturation range during the first 8 weeks of life. Outcomes for an NICU where the target oxygen saturation range was 88-98% (high oxygen) were compared to those where the target oxygen saturation range was 80-90% with the low saturation alarm set at 70% (low oxygen). Infants in the high oxygen group developed ROP requiring cryo-therapy four times as often as babies maintained with lower oxygen saturations (27% vs. 6.2%). Surviving babies in the high oxygen group were also ventilated longer (31.4 vs. 13.9 days), had more CLD at 36 weeks (46% vs. 18%), and were more likely to weigh < 3rd percentile at discharge (45% vs. 17%). There was no difference between groups in survival to 1 year of age (53% vs. 52%) or in development of cerebral palsy (17% vs. 15%).
Comment. This study was a retrospective review, not a randomized controlled trial. It compared the outcomes from 2 different NICUs without the ability to standardize care not related to the delivery of oxygen. Despite this obvious flaw in study design, the differences in outcomes between these NICUs are intriguing. I’m reminded that there are many different forms of oxygen toxicity. Only a large randomized controlled trial will answer the question of the optimal oxygen saturation range for premature babies. In the mean time, I think I’ll just tweak the pulse oximeter alarm limits down a little bit.
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