Variability in Practice and Implementation of Oxygen Target Saturation Policies in United States' Neonatal Intensive Care Units.

Objective:  This study aimed to describe target oxygen saturation (SpO₂) ranges used for premature infants in United States' neonatal intensive care units (NICUs) and to describe if these target SpO₂ ranges have changed in recent years.

Study design:  A 29-question survey focused on target SpO₂ practices and policies was distributed via the NICU medical directors listservs for the American Academy of Pediatrics Section of Neonatal-Perinatal Medicine and Pediatrix Medical Group between August and October of 2021. Results were collected via Research Electronic Data Capture (REDCap).

Results:  We received responses representing 170 unique, levels 2, 3, and 4 NICUs from 36 states. Most NICUs (130, 78%) have recently changed their SpO₂ targets in response to target SpO₂ clinical trials. Over time, the most commonly reported target SpO₂ range has shifted from 88-92% to 90-95. Of NICUs that changed limits, the most common lower SpO₂ limits increased from 88 to 90% and the upper SpO₂ limits changed from 92 to 95%. The interquartile range for lower SpO₂ limit shifted from 85-88% to 88-90% and the IQR for upper SpO₂ limit decreased from 92-95 to 94-95%. Most NICUs had designated conditions that would allow for deviations from standard target SpO₂ ranges. These most commonly include pulmonary hypertension (152, 95%), severe bronchopulmonary dysplasia (81, 51%), and retinopathy of prematurity (51, 32%).

Conclusion:  Oxygen saturation limits have changed over time with an overall increase in targeted SpO₂. However, there remains considerable interunit variation in SpO₂ policies. There is a need to achieve consensus to optimize clinical outcomes.

Key points: · What are the SpO2 ranges in United States' NICUs?. · There is a shift in SpO2 ranges for preterm infants in NICUs across United States.. · Variability still persists in SpO2 ranges for preterm infants in United States' NICUs..