Improving manual oxygen titration in preterm infants by training and guideline implementation

To study oxygen saturation (SpO₂) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO₂ within the target range (85–95%) was calculated (%SpO₂-wtr). SpO₂ was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO₂-wtr increased (median interquartile range (IQR)) 48.0 (19.6–63.9) % vs 61.9 (48.5–72.3) %; p < 0.005, with a decrease in the %SpO₂ > 95% (44.0 (27.8–66.2) % vs 30.8 (22.6–44.5) %; p < 0.05). There was no effect on the %SpO₂ < 85% (5.9 (2.8–7.9) % vs 6.2 (2.5–8) %; ns) and %SpO₂ < 80% (1.9 (1.0–3.0) % vs 1.7 (0.8–2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO₂ < 80% reduced (2 (1–2) vs 1 (1–2) minutes; p < 0.05), the occurrence of SpO₂ > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0–7) vs 1 (1–3) minute; p < 0.004).

Conclusion: Training and guideline implementation in manual oxygen titration improved SpO₂ targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter.