Iran J Pediatr. 2017 December; 27(6):e11650. Published online 2017 November 18. doi: 10.5812/ijp.11650. Research Article Percentiles of Oxygen Saturations (SpO 2 ) and Heart Rates (HR) in Premature Infants in the Delivery Room Sinan Uslu, 1, * Umut Zubarioglu, 1 Sehrinaz Sozeri, 1 Mesut Dursun, 1 Ali Bulbul, 1 Aysegul Uslu, 2 Evrim Kiray Bas, 1 Ebru Turkoglu Unal, 1 and Duygu Besnili Acar 1 1 Department of Pediatrics, Division of Neonatology, Sisli Hamidiye Etfal Educational and Research Hospital, Istanbul, Turkey 2 Division of Pediatrics, Kagithane State Hospital, Istanbul, Turkey * Corresponding author: Sinan Uslu, Assoc. Prof., MD, Sisli Hamidiye Etfal Education and Research Hospital, Halaskargazi Cad., Sisli, 34360 Istanbul, Turkey. Tel: +90-5327370015, E-mail: sinanuslumd@hotmail.com Received 2017 April 04; Revised 2017 August 07; Accepted 2017 September 02. Abstract Background: The aim was to describe reference values of oxygen saturation (SpO2 ) and heart rate (HR) in preterm infants immedi- ately after birth. Methods: The preterm (< 35 gestational age) infants who did not require any intervention were included in the study. The record- ings were taken by pulse oximetry during the first 15 minutes of life. Results: Totally 151 infants were analyzed. At 1 minute, the median (IQR) preductal SpO2 and HR were 61% (57 - 66) and 100 (90 - 107.3) bpm, rising at 5, 10 and 15 minutes to 80% (75 - 84) and 155 (142 - 164) bpm, 90% (88 - 92) and 155 (150 - 160) bpm, 96% (94 - 98) and 155 (149 - 162) bpm respectively. Conclusions: Oxygen saturation levels of preterm infants in delivery room are lower than reported in NRP guidelines. Clinicians who use pulse oximetry in HR follow up of premature babies should know HR may be < 100 bpm in first minutes of life and should avoid unnecessary positive pressure ventilation. Keywords: Newborn, Premature Infants, Oxygen Saturation, Heart Rate 1. Background More than one million newborns per year need re- suscitation all over the world and the majority of them are preterm infants (1). Published neonatal resuscita- tion algorithms suggested that oxygen supplementation should be guided according to oxygen saturation monitor- ing. These algorithms have suggested that pulse oxime- ter should be used during resuscitation of preterm infants to avoid potentially harmful hyperoxia and also hypoxia. Targeted pulse oxygen saturation (SpO 2 ) levels were deter- mined in neonatal resuscitation program (NRP) for only term neonates (2-5). However data on changes in SpO 2 in preterm infants are very limited and are not included in NRP. Heart rate (HR) measurement is used to evaluate the need for and response to resuscitation at birth. If the heart rate is persistently less than 100/min, assisted ventilation should be commenced. On the other hand, increasing HR is a basic marker of effective resuscitation, and HR > 100 bpm is the expected normal (2-5). Heart rate is usually detected by auscultation immediately after birth. Electro- cardiogram (ECG), an established and accurate method of monitoring HR, is rarely used in the delivery room for a number of reasons (6). However, it is possible to measure the HR with pulse oximetry which is increasingly used dur- ing neonatal resuscitation (4-7). The aim of this study was to determine SpO 2 and HR trends and to establish the reference values and nomo- gram in premature infants immediately after birth, mea- sured by pulse oximetry. 2. Methods 2.1. Study Population The observational prospective study was performed with preterm infants (< 35 gestational age) who did not require oxygen supplementation at the delivery room in Sisli Hamidiye Etfal Education and Research Hospital be- tween November 1, 2013 and May 1, 2015. The study pro- tocol was approved by the ethical committee and written informed consents were obtained from the parents. Ex- clusion criteria included preterms requiring oxygen, ven- tilation, medications and interventions [including contin- uous positive airway pressure (CPAP), positive pressure ventilation (PPV) or intubation] at birth, with congenital abnormalities, poor biophysical profiles, or insufficient records. Copyright © 2017, Iranian Journal of Pediatrics. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.