Comments: Remember that oxygen saturation is not a static number, but is effected by a variety of factors including positioning, feeding, crying, sleeping, stooling, congestion, reflux, etc.  If we require premature infants to maintain oxygen saturations > 94%, then we should realize that their oxygen saturations will be 100% much of the time, and their PaO2 may be >200 at times.
   
A decision to send an infant home with supplemental oxygen should not be made without careful consideration. Over-treatment with oxygen is more likely to occur in the home setting, since most of these infants are receiving straight flow oxygen at very low flow rates, and rely on crude adjustments of a flow meter to determine the amount of oxygen delivered.  If the nasal cannula is applied too tightly, resultant nasal inlet obstruction can cause increased work of breathing, hypercarbia, and hyperoxia (due to increased effective FIO2).  All of this is more serious when it occurs in the home setting where there is usually no ability to measure oxygen saturation, PaO2, or effective FI02.  Also, don’t forget to consider how well the family will be able to cope with the added stress and responsibility associated with home oxygen use.

 Data from the STOP-ROP Study suggested that maintaining high saturations in these infants increases the risk of adverse pulmonary events including pneumonia and/or exacerbations of chronic lung disease and the need for oxygen, diuretics, and hospitalization at 3 months of corrected age.  Where’s the data that accepting oxygen saturations that dip into the 80s for these infants is harmful? Do infants with cyanotic heart disease suffer brain injury or other organ damage when their oxygen saturations are in the 80s?  For further discussion of the optimal oxygen saturation range for very low birth weight infants, see 2-057, 3-043, and 4-006.  Also be sure to check out the next article (5-007) which is a commentary by Dr William Silverman on this topic published in the February 2004 issue of Pediatrics. ABK.