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Achievement of saturation targets in preterm infants less than 32 weeks gestational age in the delivery room

Presented at the Neonatal Society 2016 Spring Meeting.

White LN, Thio-Lluch M, Owen LS, Kamlin COF, Simionato L, Hooper S, Davis PG, Dawson JA

Royal Women’s Hospital, Melbourne, Australia

Background: To reduce the risks of hypoxia and hyperoxia in preterm infants in the delivery room (DR) national and international guidelines recommend titrating supplemental oxygen delivery to achieve specific oxygen saturation (SpO2) targets. Our aim was to measure the proportion of time infants < 32 weeks’ gestation spent within and outside prescribed SpO2 targets at the Royal Women’s Hospital, Melbourne during the first 10 minutes after birth

Methods: Prospective observational study (approved as an audit of practice by local research and ethics committee) using data from a preductal SpO2 sensor and an oxygen analyser measuring FiO2 in the inspiratory limb of the respiratory (T-Piece) circuit. Measurements of SpO2, HR and FiO2 were recorded every 2s. We assessed compliance with the upper SpO2 limit only when infants were receiving supplemental oxygen. SpO2 measurements were recorded as being below, within or above the target at each time point. We measured the number of times infants were continuously below or above the target range for more than 30 seconds.

Results: One hundred and six infants < 32 weeks were born during the study period with 79 excluded (research team unavailable [55], technical failure [4], inability to monitor more than one infant in twin deliveries [15], congenital anomalies [5]). Twenty-seven infants; mean (SD) 28(3.4) weeks and 962(370) grams were studied. The majority of infants received supplemental oxygen in the DR, more than half received a FiO2 of 1.0 at some stage during stabilisation. Infants were below, within and above the RWH targets for 28%, 35% and 37% of the first 10 minutes after birth respectively.

Conclusion: Preterm infants spent almost two-thirds of the first 10 minutes after birth with oxygen saturations outside prescribed target ranges. New titration strategies are required to reduce the risks of hypoxia and hyperoxia.

Corresponding author: omar.kamlin@thewomens.org.au

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