Improving manual oxygen titration in preterm infants by training and guideline implementation

To study oxygen saturation (SpO 2 ) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO 2 within the target range (85–95%) was calculated (%SpO 2 -wtr). SpO 2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO 2 -wtr increased (median interquartile range (IQR)) 48.0 (19.6–63.9) % vs 61.9 (48.5–72.3) %; p < 0.005, with a decrease in the %SpO 2 > 95% (44.0 (27.8–66.2) % vs 30.8 (22.6–44.5) %; p < 0.05). There was no effect on the %SpO 2 < 85% (5.9 (2.8–7.9) % vs 6.2 (2.5–8) %; ns) and %SpO 2 < 80% (1.9 (1.0–3.0) % vs 1.7 (0.8–2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO 2 < 80% reduced (2 (1–2) vs 1 (1–2) minutes; p < 0.05), the occurrence of SpO 2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0–7) vs 1 (1–3) minute; p < 0.004). Conclusion : Training and guideline implementation in manual oxygen titration improved SpO 2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.