title: Compliance in oxygen saturation targeting in preterm infants: a systematic review.
abstract: During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range.
  
  
  CONCLUSIONS
  The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit.
  
  
  BACKGROUND
  • The use of oxygen in preterm infants is vital, but the optimal strategyremains controversial. • Targeting SpO2 during oxygen therapy in preterm infants has beenshown to reduce mortality and morbidity.
  
  
  BACKGROUND
  • Review of the literature showed that the compliance in targeting SpO2and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting,decreasing nurse/patient ratio and automated oxygen therapy couldincrease compliance.
authors.affiliation: Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands. h.a.van_zanten@lumc.nl.
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: van Zanten
authors.affiliation: Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands. r.n.g.b.tan@lumc.nl.
authors.forename: Ratna N G B
authors.initials: RN
authors.lastname: Tan
authors.affiliation: Utrecht Medical Center, Utrecht, The Netherlands. ahoogen@lumc.nl.
authors.forename: Agnes
authors.initials: A
authors.lastname: van den Hoogen
authors.affiliation: Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands. e.lopriore@lumc.nl.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
authors.affiliation: Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, J6-S, PO Box 9600, 2300 RC, Leiden, The Netherlands. a.b.te_pas@lumc.nl.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: te Pas
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D009726:Nurses / Q000706:statistics & numerical data; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000097:blood* / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods*
chemical_list: D010100:Oxygen
keywords: Alarm limits; Automated oxygen; Compliance; Hyperoxaemia; Hypoxaemia; Preterm infant; Targeting oxygen