Commentary

Increasingly, research is being done in neonatal intensive care units (NICUs) to examine clinical practices and oxygen saturation monitoring of premature infants. Most of these studies assess incidence and severity of retinopathy of prematurity (ROP) as a primary outcome. The study by Askie et al is one of the few studies that assess growth and neurodevelopmental outcomes. At 12 months corrected age, the groups did not differ for weight, length, head circumference, or frequency of major developmental abnormalities. In addition, Askie et al showed that the higher target group had increased dependence on supplemental oxygen and more days on oxygen but did not differ from the standard target group for worst ROP. However, NICUs can vary with respect to pulse oximetry monitoring. The target range used by Askie et al may differ from those used in other NICUs. The lower SpO₂ target of 91% is higher than those reported by Chow et al, who used SpO₂ targets of 85–93% to evaluate the clinical practice of oxygen management and its effects on ROP.¹ As well, the study by Askie et al may not have been large enough to detect a significant difference between groups for several adverse outcomes, such as worst ROP, as it was powered to find large differences between groups.

The results of this study may prompt neonatal nurses to evaluate the oxygen monitoring practices of their own nurseries. Although the optimal SpO₂ range for extremely premature infants has not been identified, it appears that lower alarms settings (91–94%) may have benefits for infants, such as less respiratory support, without compromising growth and neurodevelopment. As recent ROP research is using even lower oxygen saturations, it would be interesting to repeat this study using targets of 85–93%.