When do infants need additional inspired oxygen? A review of current literature

Abstract □ 66

There is considerable uncertainty regarding the oxygen saturation threshold below which additional inspired oxygen should be given to infants with acute or chronic lung disease. In the absence of data from controlled studies, recommendations can only be based on reference values for healthy and on observational studies into the pathophysiological effects of acute and chronic hypoxia; there will be summarized in this overview. Studies on reference values for pulse oximeter saturation (SpO₂) in term and preterm infants show that, during regular breathing, 95% of infants maintain SpO₂ at, or above, 93-97%, depending on age. Studies of infants with chronic lung disease (CLD) show that (i) if SpO₂ was kept at ³93% via comparatively generous prescription of home oxygen, rates of sudden infants death were reduced, (ii) weight gain was significantly better if SpO₂ was maintained at ³93-95%, (iii) increasing SpO₂ from 82 to 93% by providing low-flow oxygen resulted in a 50% reduction in pulmonary artery pressure, (iv) O₂ administration to mildly hypoxemic infants (SpO₂ 89%) caused a 50% decrease in airway resistance, and (v) low-flow oxygen reduced the frequency of intermittent hypoxemic episodes even in infants who had values of ³90% at rest. Based on these data, it is suggested that oxygen therapy should be considered in infants whose baseline SpO₂ is <93%, and that SpO₂ should be maintained at ³95% during therapy.