Compliance in oxygen saturation targeting in preterm infants: a systematic review

Henriëtte A. van Zanten, Ratna N. G. B. Tan, Agnes van den Hoogen, Enrico Lopriore, Arjan B. te Pas

During oxygen therapy in preterm infants, targeting oxygen saturation is important for avoiding hypoxaemia and hyperoxaemia, but this can be very difficult and challenging for neonatal nurses. We systematically reviewed the qualitative and quantitative studies investigating the compliance in targeting oxygen saturation in preterm infants and factors that influence this compliance. We searched PubMed, Embase, Web of Science, Cochrane, CINAHL and ScienceDirect from 2000 to January 2015. Sixteen studies were selected, which involved a total of 2935 nurses and 574 infants. The studies varied in methodology, and we have therefore used a narrative account to describe the data. The main finding is that there is a low compliance in oxygen targeting; the upper alarm limits are inappropriately set, and maintaining the saturation (SpO2) below the upper limit presented particular difficulties. Although there is little data available, the studies indicate that training, titration protocols and decreasing workload could improve awareness and compliance. Automated oxygen regulations have been shown to increase the time that SpO2 is within the target range. The compliance in targeting oxygen during oxygen therapy in preterm infants is low, especially in maintaining the SpO2 below the upper limit. What is Known: • The use of oxygen in preterm infants is vital, but the optimal strategy remains controversial. • Targeting SpO 2 during oxygen therapy in preterm infants has been shown to reduce mortality and morbidity. What is New: • Review of the literature showed that the compliance in targeting SpO 2 and alarm settings is low. • Creating awareness of risks of oxygen therapy and benefits in targeting, decreasing nurse/patient ratio and automated oxygen therapy could increase compliance.