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Evidence-Based Practice Beliefs: What Do We Aim For? Oxygen Saturation Targets in Extremely Preterm Infants
Heidi L. Fidler BS, RN
Jacqueline McGrath

$3.95
Advances in Neonatal Care
December 2011 
Volume 11  Number 6
Pages 404 - 405
 
  PDF Version Available!

ABSTRACT
Oxygen saturation levels in the extremely preterm infant, born at less than 28 weeks' gestational age, is an area of care that has been hotly under debate for several years. For the most part, the evidence has lead us to lower target saturation levels as a way to decrease the rate and severity of retinopathy of prematurity (ROP) as well as the number of free radicals that may slow lung healing.1 Recent unexpected findings from large, controlled, multicenter trials are leading many neonatal intensive care unit (NICU) teams to review their policies for oxygen saturation (SpO2) limits.Has your NICU team recently reviewed its policy for SpO2 limits for extremely preterm infants? If not, maybe it is time to reconsider your guidelines. This is an area where the newest evidence must be reevaluated and considered as a basis for any change. Given where the previous evidence was leading us, these newest results might be surprising and give pause to our current practices.Recent findings from the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) Study Group, part of the Neonatal Research Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, support previous results that infants maintained on lower SpO2 levels, compared with those on higher levels, have a lower risk of developing severe ROP (8.6% vs 17.9%; relative risk, 0.52; 95% confidence interval [CI], 0.37-0.73; P < .001).1 But, they also bring to light a troubling possibility. Lower SpO2 levels may lead to increased mortality.In this SUPPORT trial,1 researchers gathered data from 1316 infants, who were born between 24 weeks 0 days' and 27 weeks 6 days' gestation and randomized them to one of 2 target levels of oxygen saturation, 85% to 89% or 91% to 95%. The infants were also randomized to one of 2 ventilation protocols, the results of which will not be discussed here. Blinding was achieved through the use of electronically altered pulse oximeters that were

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