Targeted oxygen therapy in special care nurseries: is uniformity a good thing?

Aim: There is wide variation in the commencement of inspired oxygen (FiO₂) and the oxygen saturation (SpO₂) 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). Conclusion: 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.