Observing the resuscitation of very preterm infants: Are we able to follow the oxygen saturation targets?

Background: Since 2010, the European Resuscitation Council (ERC) guidelines advise oxygen saturation (SpO(2)) targets for the first 10 min of resuscitation after birth. Unfortunately, the control of SpO(2) in newborn infants is difficult. Aim: To determine to what extent SpO(2) levels match the ERC targets during the resuscitation of very preterm infants, and how well the SpO(2) is kept within the high and low limits until the infants are transported to the NICU. Methods: In a single-centre observational study, the SpO(2) and fraction of inspired oxygen (FiO(2)) were collected during the resuscitation of very preterm infants with a gestational age (GA) <= 30 weeks. Results: A total of 78 infants were included [median (IQR): GA 274/7 (26-286/7) weeks, birth weight 945 g (780-1140)]. During the initial 10 min after birth, large variations in SpO(2) were observed with deviations above the target [median (IQR)] of 4.4% SpO(2) (1.4-6.5), and below the target of 8.2% SpO(2) (2.8-16.0). After the first 10 min, the SpO(2) levels were respectively above and below the limit for 11% (0-27) and 8% (0-23) of the time. Conclusion: During the resuscitation of very preterm infants, large deviations of the SpO(2) from the ERC targets are observed. During the first minutes of resuscitation the deviations were likely caused by an inability to control the SpO(2), whereas later deviations were due to weaning, pauses in respiratory support (i.e. intubation) and over exposure to oxygen. Changing the SpO(2) targets to a target range that depicts the acceptable deviation might be helpful in providing better respiratory support. (C) 2013 Elsevier Ireland Ltd. All rights reserved.