ORIGINAL ARTICLE Pulse oximetry in very low birth weight infants: can oxygen saturation be maintained in the desired range? AR Laptook 1 , W Salhab 2 , J Allen 3 , S Saha 4 and M Walsh 5 1 Brown Medical School, Providence, RI, USA; 2 University of Texas Southwestern Medical Center, Dallas, TX, USA; 3 Parkland Hospital, Dallas, TX, USA; 4 Research Triangle Institute, Research Triangle Park, NC, USA and 5 Case Western Reserve University, Cleveland, OH, USA Objective: To determine if a change in the pulse oximeter goal range and high alarm limit for oxygen saturation (SpO 2 ) alters the distribution of SpO 2 for premature infants in oxygen. Study design: This was a prospective, observational analysis. For group 1 (February 2002 to April 2002, n ¼ 23), pulse oximeter alarms were set at 80% (low) and 96% (high), and the goal range was 90–95%. For group 2 (May 2002 to August 2003, n ¼ 49), the high alarm was lowered to 94%, and the goal range was 88 to 94%. The SpO 2 values for 24 h were downloaded from Nellcor pulse oximeters during the two periods and the percent time within, above and below the goal range was derived and compared. Results: Groups were similar except for use of post-natal steroids (group 2>1). The percent time within (57.7±9.8 vs 59.4±12.4%), above (15.4±10.6 vs 14±9.4%) and below (26.9±9.7 vs 26.6±10.2%) the goal range was similar for groups 1 and 2, respectively. However, the percent time with SpO 2 <80% increased significantly for group 2 (4.0±2.7 vs 1.9±1.4%). Conclusions: Changes in pulse oximeter policy and alarms in labile, sick premature infants need evaluation for their effects on the distribution of SpO 2 values before routine use. Journal of Perinatology (2006) 26, 337–341. doi:10.1038/sj.jp.7211500; published online 6 April 2006 Keywords: pulse oximetry; oxygen saturation; oxygenation; premature infants Introduction Monitoring systemic oxygenation in sick neonates to avoid hypoxia and hyperoxia is a routine aspect of neonatal intensive care. This is especially important for premature infants given the putative role of oxygen in the pathogenesis of morbidities such as Bronchopulmonary Dysplasia (BPD) and Retinopathy of Prematurity. 1–4 Pulse oximeters are a commonly used biomedical device to monitor oxygenation in preterm infants. 5 Advantages of pulse oximetry are a rapid response time to changes in oxygen saturation, provision of continuous information non-invasively and absence of the need to calibrate before use. 6 Although pulse oximetry is prevalent in Neonatal Intensive Care Units (NICU), important questions and concerns remain regarding its clinical use as the primary means of monitoring oxygenation for infants requiring supplemental oxygen. 7 In fact, there is sparse information to demonstrate if bedside providers are able to maintain oxygen saturation (SpO 2 ) in a designated goal range of SpO 2 . Thus, the objective of this study was to determine if a change in both the NICU pulse oximeter goal range and the high alarm limit for SpO 2 altered the distribution of SpO 2 values within, above and below the goal range among preterm infants. Materials and methods This study was nested within a National Institute of Child Health and Human Development Neonatal Research Network (NRN) multi-center trial of Benchmarking to reduce BPD. The latter was a randomized trial in which NICUs were randomized to either implement changes in care practices as part of a Benchmarking initiative, or function as a control center without a planned benchmarking process. This report describes a specific benchmarking initiative conducted at a single center, Parkland Hospital, which was one of the center NICUs randomized to Benchmarking. Parkland Hospital is the sole city-county hospital facility for Dallas, Texas providing neonatal intensive care for a largely inborn population that is predominantly Hispanic (E70%) with annual NICU admissions of 1049 and 1085 for 2002 and 2003, respectively. This was a prospective, observational analysis of an SpO 2 target and alarm limit change on resultant SpO 2 distribution. The inclusion criteria for the patient population consisted of in-born premature infants, birth weight of 501 to 1250 g and receiving continuous supplemental oxygen (either with or without ventilator Received 3 November 2005; revised 27 February 2006; accepted 6 March 2006; published online 6 April 2006 Correspondence: Dr AR Laptook Women and Infants’ Hospital of Rhode Island, 101 Dudley Street, Suite 1100, Providence, RI 02905, USA. E-mail: alaptook@wihri.org Journal of Perinatology (2006) 26, 337–341 r 2006 Nature Publishing Group All rights reserved. 0743-8346/06 $30 www.nature.com/jp