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Oxygen Saturation SpO2 Level Targeting - Premature Neonates

  • Introduction

    In premature neonates, oxygen toxicity is associated with the development of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD).  Reducing the levels and time of oxygen exposure in this patient population will likely decrease these morbidities.

    The goal of SpO2 level targeting for premature neonates is to adequately deliver oxygen to the tissue without causing the complications of oxygen toxicity. Premature neonates' SpO2 readings are often labile and difficult to keep within a narrow range. The care-team must aim to maintain SpO2 levels within this range.

    The aim of this guideline is to provide medical and nursing staff at the Royal Children's Hospital with clear parameters within which premature neonates' SpO2 levels should be maintained, when the neonate is in oxygen.

    Definition of Terms

    • Premature Neonate:  Any neonate born before 37 weeks completed gestation
    • Gestational Age:  The number of weeks and days of completed gestation at birth
    • Corrected Age:  Gestational age at birth plus chronological age
    • SaO2:  Arterial oxygen saturation
    • SpO2:  Percentage of haemoglobin that is saturated with oxygen.  Used to estimate SaO2
    • ROP:  Retinopathy of Prematurity - An alteration of the normal retinal vascular development, mainly affecting premature neonates (<32 weeks gestation or 1250g birthweight), which can lead to visual impairment and blindness.  It can occur in neonates treated with any concentration of oxygen greater than 21%.
    • BPD:  Bronchopulmonary Dysplasia - A chronic lung disease, mainly affecting premature neonates, that develops after oxygen therapy and mechanical ventilation.  It is characterised by decrease in alveolar number and development of cystic changes in the lungs and oxygen requirement beyond 36 weeks corrected gestation.

    Assessment

    Neonates born below 32 weeks completed gestational age, that require supplemental oxygen therapy (i.e. oxygen concentration exceeding 21%) for any amount of time, should have their SpO2 levels targeted, while they are receiving supplemental oxygen. This targeting should continue until they reach the corrected age of 40 weeks gestation.

    Management

    For the high risk group as defined above, the SpO2 target range is 91-95%, with monitor alarm limits set at 89% and 95%.

    For neonates in the high risk group that are in air, the upper alarm limit can be set at 100%

    For neonates born above 32 weeks completed gestation that require oxygen therapy, the SpO2 target range is 91-95%, with monitor alarm limits set at 89% and 95% (i.e. the same ranges as for premature neonates).

    Special Considerations

    For neonates that have cardiac disease or pulmonary hypertension, medical staff should prescribe monitor alarm limits for each individual neonate.  This should be documented by the medical staff in the patient history and treatment orders.

    Evidence Table

    Evidence table for Oxygen Saturation (SpO2) Level Targeting - Premature Neonates

    Please remember to read the disclaimer.

    The development of this clinical guideline was coordinated by Sharlene Pattie, Clinical Nurse Educator, McKinnon Nursing Education. Approved by the Clinical Effectiveness Committee. Authorised by Bernadette Twomey, Executive Director Nursing Services. First published May 2009, current as of December 2012.

     

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