Administration of supplemental oxygen is one of the most common interventions in the treatment of critically ill neonates and may lead to oxygen toxicity. Titrating the administration of supplemental oxygen to match the needs of very and extremely low birth weight infants may decrease the risk of excessive oxygen delivery and adverse outcomes such as retinopathy of prematurity, bronchopulmonary dysplasia, and death. While saturation targeting and oxygen titration continues to be critically evaluated in the intensive care setting, this practice has not been evaluated in the transport environment. Our objective was to evaluate the practice, safety and effectiveness of supplemental oxygen delivery during interfacility transport of very and extremely low birth weight infants.
This was a single center, retrospective cohort study of infants less than 1500 grams, <24 hours of age, receiving supplemental oxygen (titrated and nontitrated), transported by the Children’s Mercy (CMH) Critical Care Transport team, and admitted to the CMH Neonatal Intensive Care Unit between January 2000 and December 2009. Outcomes of interest included ABG within the first hour of admission (a measure of oxygen exposure), base deficit (a measure of hypoxemia), and admission mean arterial blood pressure (a measure of cardiovascular stability). Infants with multiple congenital anomalies or cyanotic heart defects were excluded. The data were analyzed by ANOVA and chi-square tests.
Of 237 infants, 83 infants received nontitrated and 154 received titrated supplemental oxygen. Both groups had similar gestational age (26±2.3 vs 26±2.3 weeks), birthweight and 5-minute APGAR scores. Excessive oxygen exposure (paO2 >90 torr) occurred in 53% (95% CI: 42.3% to 63.8%) vs 32.5% (25.1% to 39.9%) in nontitrated vs titrated infants, respectively. Mean paO2 was significantly higher in nontitrated than in titrated infants, 114±80 torr vs 87.7±50.9 torr (p<0.005). Admission base deficit and mean arterial blood pressure did not differ between the two groups
Titration of supplemental oxygen during interfacility transport of very and extremely low birth weight infants decreases the risk of hyperoxia (paO2 >90 torr). There is no evidence that titration increases the risk of hypoxia or cardiovascular compromise.