Neonatal target oxygen levels for preterm infants
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
Oxygen supplementation is an important component of intensive neonatal care for the preterm infant. Ideally, oxygen administration provides adequate oxygenation for the metabolic needs of the neonate while avoiding the consequences of both hypoxemia and hyperoxia. However, it remains clinically challenging to define the optimal target levels of oxygen, especially in preterm infants.
Establishing neonatal target oxygen level for the preterm infant is discussed here. Oxygen delivery and monitoring and mechanical ventilation in the newborn are discussed separately. (See "Noninvasive oxygen delivery and oxygen monitoring in the newborn".)
SpO2 AND PaO2
Normal values for hemoglobin oxygen saturation (SpO2) reach or exceed 80 percent within 10 minutes of birth in term and healthy preterm infants without supplemented oxygen . In general, arterial partial pressure of oxygen (PaO2) values of 50 to 80 mmHg are adequate to meet metabolic demands of the neonate. In preterm infants, lower levels (PaO2 40 to 50 mmHg) are acceptable, partly due to the relative greater proportion of fetal hemoglobin (HbF).
Use of SpO2 for targeting oxygen levels — For neonates who receive supplemental oxygen therapy, established neonatal target oxygen levels are based on hemoglobin oxygen saturation (SpO2) since most neonatal intensive care units (NICUs) use continuous noninvasive pulse oximetry, which measures SpO2, to monitor oxygenation. Periodic arterial blood gas (ABG) samples are obtained that measure arterial oxygen tension (PaO2) to further refine safety and efficacy of oxygen therapy and correlate with pulse oximetry measurements, especially for infants at risk for either hypoxemia or hyperoxemia.
However, ABG measurements require blood sampling, either through indwelling catheters or percutaneous puncture of a palpable artery. ABG measurements may change during percutaneous punctures as the infant responds to the procedure, so clinicians should be mindful of this in interpreting the results. (See "Noninvasive oxygen delivery and oxygen monitoring in the newborn", section on 'Pulse oximetry' and "Noninvasive oxygen delivery and oxygen monitoring in the newborn", section on 'Arterial blood gas measurement'.)
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