Targeted oxygen therapy in special care nurseries: is uniformity a good thing?
OBJECTIVE
There is wide variation in the commencement of inspired oxygen (FiO2) and the oxygen saturation (SpO(2) ) targets set in special care nurseries (SCNs). Evidence supports minimising unnecessary oxygen exposure. Does the introduction of a protocol advocating the uniform approach of commencing FiO2 at 30% and targeting SpO2 of 94-96% for infants ≥ 33 weeks gestation with respiratory distress reduce oxygen exposure?


METHODS
A 'Before After' study was undertaken in three SCNs. Data were recorded for all infants admitted to the SCNs who required oxygen over a 3-year period. Infants were analysed in gestational age groups: 33-36 weeks (late preterm) and +37 weeks (term/post-term).


RESULTS
Of the 19,830 infants born, 868 (4%) were treated with oxygen. The introduction of an oxygen-targeting protocol resulted in a statistically and clinically significant reduction in the proportion of infants who were treated with any oxygen for 1 h or more, 4 h or more and in the proportion who received >30% FiO2 for 1 h or more (all P ≤ 0.01). This reduction was significant for infants of both gestational age groups. The median duration of oxygen for term/post-term infants was reduced from 12 h pre-protocol to 10 h post-protocol (P= 0.01); however, no significant difference was found for the preterm group (reduced from 11 to 8 h, P= 0.07).


CONCLUSIONS
Introduction of a uniform oxygen protocol in SCNs for infants ≥ 33 weeks gestation with respiratory distress reduces the number of infants receiving oxygen and, in term infants, the duration of oxygen exposure.
Department of Paediatrics, Gosford District Hospital, Northern Sydney Central Coast Area Health Service, Gosford, Australia. abuckmaster@nsccahs.health.nsw.gov.au
Adam
A
Buckmaster
Gaston
G
Arnolda
Ian
I
Wright
Jann
J
Foster
D002985:Clinical Protocols; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy; D008297:Male; D009517:New South Wales; D009725:Nurseries, Hospital / Q000592:standards*; D010092:Oximetry; D010102:Oxygen Inhalation Therapy / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012131:Respiratory Insufficiency / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome