A Review of Oxygen Physiology and Appropriate Management of Oxygen Levels in Premature Neonates.
Allyson Kayton, Paula Timoney, Lyn Vargo and 1 others
PMID 28953054WHAT IT FOUND
Room air (21% oxygen) is safer than 100% oxygen for starting neonatal resuscitation.
Targeting saturation 91% to 95% may be safer than 85% to 89%; set oximeter alarms to avoid below 85% and above 95%.
Key findings
01Room air (21% oxygen) is safe and effective for neonatal resuscitation, and a meta-analysis reported lower mortality risk than 100% oxygen.
02In pooled BOOST II data, an oxygen saturation target of 85% to 89% was associated with increased risk of death or disability and death alone compared with 91% to 95%.
03Oximeter alarms should be set with a lower limit of 85% or greater and a high limit of 95%, and inhaled oxygen should be reduced if saturation exceeds 95%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a narrative review, not a new trial, so it cannot show how these oxygen targets worked in a single contemporary NICU. The large studies gave mixed results, and the review says the optimal target range remains uncertain. Oximeter readings may not match intended targets, which can make results hard to apply. Non-approved pulmonary vasodilators such as sildenafil, prostacyclin, bosentan, and milrinone have limited or exploratory safety and efficacy data.
The easy way to misread this
Do not read the 91% to 95% target as proven for every premature neonate. The review says optimal target ranges remain uncertain and results across large studies were mixed.