Recommendation ID

Does targeting higher oxygen saturations of 92% to 97% in preterm babies lead to improved survival without significant complications?

Any explanatory notes
(if applicable)

The evidence on the best method for measuring oxygen levels in diagnosing hyperoxia or hypoxia in preterm babies was very limited. There were no studies assessing the diagnostic accuracy of SpO2(peripheral capillary oxygen saturation) compared with the standard PaO2 (partial pressure of arterial oxygen) that met the review's inclusion criteria. The committee agreed, based on clinical consensus and their experience of clinical practice, that SpO2 should remain the first-line method for continuous monitoring of oxygen saturation levels in preterm babies because of its widespread availability and non-invasive nature. The committee agreed that arterial sampling of partial pressure of oxygen remained the 'gold standard', but is not always possible and can never be continuous.

The only evidence on tcPO2 (transcutaneous oxygen) was 1 study from the 1970s, and the way this procedure is performed has changed substantially since then. However, tcPO2 is currently used in clinical practice, and in the committee's experience it can provide useful information. This is particularly the case for preterm babies on invasive ventilation who are clinically unstable and need continuous monitoring to guide management, and in whom SpO2 may not be accurate.

Because of the lack of good evidence, the committee agreed that further research needs to be conducted looking at the diagnostic accuracy of tcPO2 and SpO2 against the gold standard arterial oxygen saturation in diagnosing hyperoxia and hypoxia in a preterm baby population.

There was evidence that higher target oxygen saturation levels reduce mortality. Although a higher target is associated with an increase in retinopathy of prematurity and an increased risk of BPD, the evidence suggested no increase in severe visual impairment at 18 months, and the reduction in mortality was considered to offset the increased risk of BPD. The committee were aware that target oxygen levels (up to 97%) may be more beneficial but there was no evidence to support this, so they made a research recommendation.

Source guidance details

Comes from guidance
Specialist neonatal respiratory care for babies born preterm
Date issued
April 2019

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 02/04/2019