Safe oxygen saturation targeting and monitoring in preterm infants: can we avoid hypoxia and hyperoxia?

Oxygen is a neonatal health hazard that should be avoided in clinical practice. In this review, an international team of neonatologists and nurses assessed oxygen saturation (SpO2) targeting in preterm infants and evaluated the potential weaknesses of randomised clinical trials.

[1]  M. Enserink Scientific ethics. Fraud-detection tool could shake up psychology. , 2012, Science.

[2]  Augusto Sola,et al.  ausência de evidência não é evidência de ausência , 2007 .

[3]  L Zhang,et al.  Accuracy of symptoms and signs in predicting hypoxaemia among young children with acute respiratory infection: a meta-analysis. , 2011, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[4]  Christian F Poets,et al.  Under-recognition of alarms in a neonatal intensive care unit , 2013, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[5]  J. H. Comroe THE LOCATION AND FUNCTION OF THE CHEMORECEPTORS OF THE AORTA , 1939 .

[6]  C. Kamlin,et al.  Comparison of heart rate and oxygen saturation measurements from Masimo and Nellcor pulse oximeters in newly born term infants , 2013, Acta paediatrica.

[7]  Frank van Bel,et al.  Cerebral oxygenation, extraction, and autoregulation in very preterm infants who develop peri-intraventricular hemorrhage. , 2013, The Journal of pediatrics.

[8]  R. Tibshirani,et al.  Increasing value and reducing waste in research design, conduct, and analysis , 2014, The Lancet.

[9]  A. Sola,et al.  An evident view of evidence-based practice in perinatal medicine: absence of evidence is not evidence of absence. , 2007, Jornal de pediatria.

[10]  D. Fanelli “Positive” Results Increase Down the Hierarchy of the Sciences , 2010, PloS one.

[11]  Steven J. Barker,et al.  The effects of motion on the performance of pulse oximeters in volunteers (revised publication). , 1997 .

[12]  J. Ioannidis Why Most Published Research Findings Are False , 2019, CHANCE.

[13]  M E Morgan,et al.  Pulse oximetry in neonatal care. , 1986, Archives of disease in childhood.

[14]  J. Ioannidis,et al.  Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices , 2014, Implementation Science.

[15]  J. Ioannidis Why Most Published Research Findings Are False , 2005, PLoS medicine.

[16]  A. Act Target Ranges of Oxygen Saturation in Extremely Preterm Infants , 2010 .

[17]  B. Stenson,et al.  Arterial oxygen tension (Pao2) values in infants <29 weeks of gestation at currently targeted saturations , 2008, Archives of Disease in Childhood Fetal and Neonatal Edition.

[18]  J. H. Comroe,et al.  Retrospectroscope: Insights into Medical Discovery , 1977 .

[19]  D. Henderson-smart,et al.  Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. , 2001, The Cochrane database of systematic reviews.

[20]  J. H. Comroe,et al.  Mental changes occurring in chronically anoxemic patients during oxygen therapy. , 1950, Journal of the American Medical Association.

[21]  Annemarie Mol,et al.  Proving or Improving: On Health Care Research as a Form of Self-Reflection , 2006, Qualitative health research.

[22]  E. Bancalari,et al.  Oxygenation targets and outcomes in premature infants. , 2013, JAMA.

[23]  A. Sola Oxygen in neonatal anesthesia: friend or foe? , 2008, Current opinion in anaesthesiology.

[24]  A. Sola,et al.  Effects of oxygen on the development and severity of retinopathy of prematurity. , 2013, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[25]  E. Bancalari,et al.  Control of oxygenation during mechanical ventilation in the premature infant. , 2012, Clinics in perinatology.

[26]  Laverne Estanol,et al.  Performance of three new-generation pulse oximeters during motion and low perfusion in volunteers. , 2012, Journal of clinical anesthesia.

[27]  Billie L Short,et al.  Clinical use of new-generation pulse oximeters in the neonatal intensive care unit. , 2005, American journal of perinatology.

[28]  Matthias Briel,et al.  Reflections on meta-analyses involving trials stopped early for benefit: Is there a problem and if so, what is it? , 2013, Statistical methods in medical research.

[29]  K. Tremper,et al.  False Alarms and Sensitivity of Conventional Pulse Oximetry Versus the Masimo SET™ Technology in the Pediatric Postanesthesia Care Unit , 2000, Anesthesia and analgesia.

[30]  S J Barker,et al.  Effects of Motion on the Performance of Pulse Oximeters in Volunteers , 1996, Anesthesiology.

[31]  Christopher H Schmid,et al.  Achieved Versus Intended Pulse Oximeter Saturation in Infants Born Less Than 28 Weeks' Gestation: The AVIOx Study , 2006, Pediatrics.

[32]  R. Brouillette,et al.  Differences in pulse oximetry technology can affect detection of sleep-disorderd breathing in children. , 2002, Anesthesia and analgesia.

[33]  Problems of stopping trials early , 2012, BMJ : British Medical Journal.

[34]  L. Moore,et al.  Arterial oxygen saturation in Tibetan and Han infants born in Lhasa, Tibet. , 1995, The New England journal of medicine.

[35]  G. Bedell The Lung: Clinical Physiology and Pulmonary Function Tests. , 1963 .

[36]  N. Kanaya,et al.  A Comparison of the Failure Times of Pulse Oximeters During Blood Pressure Cuff-Induced Hypoperfusion in Volunteers , 2004, Anesthesia and analgesia.

[37]  A. Sola,et al.  [Pulse oximetry in neonatal care in 2005. A comprehensive state of the art review]. , 2005, Anales de pediatria.

[38]  B. Schmidt,et al.  Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. , 2013, JAMA.

[39]  J. Deeks,et al.  Pulse oximetry screening for congenital heart defects in newborn infants (PulseOx): a test accuracy study , 2011, The Lancet.

[40]  Lily C Chow,et al.  Can changes in clinical practice decrease the incidence of severe retinopathy of prematurity in very low birth weight infants? , 2003, Pediatrics.

[41]  Augusto Sola,et al.  Oximetría de pulso en la asistencia neonatal en 2005. Revisión de los conocimientos actuales , 2005 .

[42]  G. Guyatt,et al.  Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression analysis. , 2010, JAMA.

[43]  Armando Castillo,et al.  Avoiding hyperoxemia during neonatal resuscitation: time to response of different SpO2 monitors , 2011, Acta paediatrica.

[44]  W. Hay,et al.  Reliability of Conventional and New Pulse Oximetry in Neonatal Patients , 2002, Journal of Perinatology.

[45]  O. Saugstad Take a breath—but do not add oxygen (if not needed) , 2007, Acta paediatrica.

[46]  Augusto Sola,et al.  Pulse Oxygen Saturation Levels and Arterial Oxygen Tension Values in Newborns Receiving Oxygen Therapy in the Neonatal Intensive Care Unit: Is 85% to 93% an Acceptable Range? , 2008, Pediatrics.

[47]  Ola Didrik Saugstad,et al.  Optimal Oxygenation of Extremely Low Birth Weight Infants: A Meta-Analysis and Systematic Review of the Oxygen Saturation Target Studies , 2013, Neonatology.

[48]  T. Gale,et al.  Oxygen saturation targeting in preterm infants receiving continuous positive airway pressure. , 2014, The Journal of pediatrics.

[49]  M. Laman,et al.  Can clinical signs predict hypoxaemia in Papua New Guinean children with moderate and severe pneumonia? , 2005, Annals of tropical paediatrics.

[50]  C. Poets,et al.  Pulse oximeters’ reliability in detecting hypoxemia and bradycardia: Comparison between a conventional and two new generation oximeters , 2000, Critical care medicine.

[51]  I. Adams-Chapman,et al.  Avoiding hyperoxia in infants ⩽1250 g is associated with improved short- and long-term outcomes , 2006, Journal of Perinatology.

[52]  J. Ioannidis The importance of potential studies that have not existed and registration of observational data sets. , 2012, JAMA.

[53]  K. Dietz,et al.  Averaging time, desaturation level, duration and extent , 2012, Archives of Disease in Childhood: Fetal and Neonatal Edition.

[54]  N. Finer,et al.  The Effect of Averaging Time on Oximetry Values in the Premature Infant , 2010, Pediatrics.

[55]  R. Ehrenkranz,et al.  Temporal quantification of oxygen saturation ranges: an effort to reduce hyperoxia in the neonatal intensive care unit , 2014, Journal of Perinatology.

[56]  K. Sandberg,et al.  Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns , 2009, BMJ : British Medical Journal.

[57]  J. Graham Impact of pulse oximetry screening on the detection of duct dependent congenital heart disease: a Swedish prospective screening study in 39 821 newborns , 2010 .

[58]  R. Sahni,et al.  Motion resistant pulse oximetry in neonates , 2003, Archives of disease in childhood. Fetal and neonatal edition.

[59]  B. Poindexter,et al.  Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. , 2012, The New England journal of medicine.

[60]  Michele Walsh,et al.  Evidence for oxygen use in preterm infants , 2012, Acta paediatrica.

[61]  James R. Allen,et al.  Resuscitation of Preterm Neonates With Limited Versus High Oxygen Strategy , 2013, Pediatrics.

[62]  Augusto Sola,et al.  A randomised controlled trial of an automated oxygen delivery algorithm for preterm neonates receiving supplemental oxygen without mechanical ventilation , 2014, Acta paediatrica.

[63]  A. Sola,et al.  Oxygen as a neonatal health hazard: call for détente in clinical practice , 2007, Acta paediatrica.

[64]  W. S. Fowler,et al.  Lung function studies. VI. Detection of uneven alveolar ventilation during a single breath of oxygen. , 1951, The American journal of medicine.

[65]  Jonathan A C Sterne,et al.  Sifting the evidence—what's wrong with significance tests? , 2001, BMJ : British Medical Journal.

[66]  M. Meyer,et al.  Oxygen saturation and outcomes in preterm infants. , 2013, The New England journal of medicine.

[67]  Jennifer Dawson,et al.  Compliance With Alarm Limits for Pulse Oximetry in Very Preterm Infants , 2007, Pediatrics.

[68]  N. Finer,et al.  Achieving targeted pulse oximetry values in preterm infants in the delivery room. , 2013, The Journal of pediatrics.

[69]  K. Wright,et al.  A physiologic reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity. , 2006, Transactions of the American Ophthalmological Society.

[70]  B. Poindexter,et al.  Target ranges of oxygen saturation in extremely preterm infants. , 2010, The New England journal of medicine.

[71]  Research accomplishments that are too good to be true , 2013, Intensive Care Medicine.

[72]  John P A Ioannidis,et al.  Ensuring the integrity of clinical practice guidelines: a tool for protecting patients , 2013, BMJ : British Medical Journal.