OXYGEN SATURATION TARGETS
Maintaining oxygen
saturation within target
range
Use this guideline for preterm babies
<36 weeks corrected gestational age
Alternative saturation targets or
strategy may be specified for babies
with congenital heart disease or those
at risk of PPHN
Setting alarm limits
If currently <36 weeks corrected age
Target range SpO 9195%
2 SpO2 95%
Babies breathing supplemental oxygen
Low alarm at 89% and high alarm at 96%
Babies breathing air
Low alarm at 89% and high alarm at 100%
RESPONDING TO OXYGEN
SATURATION ALARMS
General principles
Monitor
Assess monitor trace and baby before
increasing inspired oxygen. In
particular, assess:
babys position
presence of secretions that may need
to be removed
position of endotracheal tube or other
device for delivering oxygen
Adjust inspired oxygen
Change inspired oxygen in increments
of 13% at a time except before
procedures or with significant
desaturations below 70%. In these
circumstances, see below
Avoid titrating target saturation with
large and frequent increases and
decreases in inspired oxygen
PRINCIPLES
Usual unit target range SpO2 9195%
for preterm babies <36 weeks
corrected gestational age who are
breathing on supplemental oxygen
If different target range, see right-hand
column of table below
Prescribe oxygen on babys drug chart
specifying target range
If currently 36 weeks corrected age
OR born 34 weeks Target
Babies breathing supplemental oxygen
Low alarm at 94% and high alarm at 99%
Babies breathing air
Low alarm at 94% and high alarm at 100%
small frequent tweaking of inspired
oxygen by 13% between 4050%
oxygen is much better than
intermittently swinging between
3080% oxygen to achieve same
target range
If it is necessary to increase
inspired oxygen by >510%, or to
introduce (or change)
CPAP or ventilation
Specific circumstances
High alarm
silence alarm and observe for an
alarm cycle (3 min)
if alarm still sounding after a cycle,
decrease inspired oxygen by 13%
continue reducing inspired oxygen by
13% every alarm cycle until
saturation stable in desired range
OXYGEN SATURATION TARGETS
Low alarm
silence alarm and observe
assess waveform and heart rate
baby: check position of endotracheal
tube or other oxygen delivery device
e.g. nasal prongs or mask, and
consider suction or repositioning
If desaturation persists after above
checks, increase inspired oxygen by
13% for moderate desaturation
(SpO2 >70%)
significant desaturations (SpO2 <70%),
double baseline inspired oxygen
(increase by at least 20%) until SpO2
increases to 90%, then wean rapidly to
within 3% of baseline inspired oxygen

Handling or procedures
If history of significant desaturation
with handling or procedures, increase
inspired oxygen by 510% before
handling or procedure
increase PEEP (or PIP if CO2 rising)
by 12 cm for a few minutes
After procedure, once SpO2 stabilises,
wean inspired oxygen rapidly to
baseline

Labile cases
Some sick babies will be particularly
labile and it is challenging to maintain
SpO2 in target range. It is important to
remain patient and continue to follow
guidance above
In rare cases, individualised
adjustments to alarm settings may be
necessary after discussion with
medical team
OXYGEN ON DISCHARGE
OBJECTIVE
To put an effective plan in place to
allow oxygen-dependent babies to be
cared for safely at home
INDICATIONS FOR HOME
OXYGEN THERAPY
Chronic lung disease with ongoing
demand for additional inspired oxygen
Criteria
Clinically stable on oxygen therapy via
nasal cannulae for 2 weeks
SpO2 95% after 36 weeks gestation
on <0.5 L/min oxygen
Cyanotic congenital heart disease: a
lower value may be appropriate, set
threshold on an individual basis (liaise
with paediatric cardiologists)
Overnight pulse oximetry study when
on stable oxygen for one week before
discharge
mean SpO2 should be 93% without
frequent periods of desaturations
SpO2 should not fall below 90% for >5%
of the artefact-free recording period
If using <0.5 L/min ensure baby able to
cope with short periods in air in case
their nasal cannulae become dislodged
Routine continuous oxygen monitoring
discontinued including at feeding,
awake and sleeping times, apart from
checks at 4-hrly intervals twice weekly
before discharge
Thermo-control well established
Feeding orally 34 hrly and gaining
weight
some babies may require tube
feeding, if all other criteria are met,
this should not hinder discharge
Final decision on suitability for
discharge lies with consultant
PREPARATION FOR
DISCHARGE
Make arrangements with
parents
Discuss need for home oxygen with
parents
Obtain consent for home oxygen
supply and for sharing information with
oxygen supplier. This is obligatory
before supplier can be contacted with
patient details
Arrange multidisciplinary meeting one
week before discharge with
parents/carers, community nurse,
health visitor and member of neonatal
unit (NNU)
Arrange discharge plan
Parent training
Resuscitation techniques (2 adults)
No smoking in the house or anywhere
in babys environment
Recognition of babys breathing
pattern, colour and movements
Use of oxygen equipment (2 adults)
Competence in tape application for
nasal prongs and skin care (water
based emollients)
What to do in case of emergency:
contact numbers
direct admission policy
fire safety and insurance advice (car
and home)
OXYGEN ON DISCHARGE
Organise oxygen
Prescribing clinician to complete Home
Oxygen Order. Do not send home on
less than 0.1 L (even if on <0.1 L in
NNU)
fax completed form to appropriate
supplier
file original in babies notes
AFTERCARE
As oxygen dependent babies (e.g.
chronic lung disease) are at increased
risk of contracting respiratory syncytial
virus (RSV), give palivizumab and
influenza vaccine (see Immunisations
guideline and Palivizumab guideline)
Refer to local guidelines for follow-up

Discharge checklist
Discharge plan implemented
Plan discharge for beginning of week
to ensure staff available in event of
problems
Oxygen supply and equipment installed
in the home
Baby will go home on prescribed
amount of oxygen; this may be altered
on direction of medical or nursing staff,
or in event of emergency
GP and other relevant professionals
(also fire and electricity companies,
although oxygen supplier usually does
this) informed of date and time of
discharge
Community team briefed to arrange
home visit well in advance of discharge
to ensure conditions suitable and
equipment correctly installed
Parents/carers trained to care for baby
safely at home and have support
contact numbers
Open access to paediatric ward