When do infants need additional inspired oxygen? A review of the current literature

There is considerable uncertainty regarding the oxygen saturation threshold below which additional inspired oxygen should be given to infants with acu te or chronic lung disease. In the absence of data from controlled studies, recommendations can only be based on reference values for healthy infants and on observational studies regarding the pathophysiological effects of ac ute and chronic hypoxia. Reference values for pulse oximeter saturations (S pO(2)) in term and preterm infants show that during normal breathing 95% of infants maintain SpO(2) at or above 93-97%, depending on age. Studies of i nfants with chronic lung disease (CLD) show that (1) when SpO(2) was kept a t greater than or equal to 93% by administration of home oxygen, rates of s udden infant death were reduced; (2) weight gain was significantly better w hen SpO(2) was maintained at greater than or equal to 93-95%, (3) increasin g SpO(2) from 82 to 93% by delivering low-flow oxygen resulted in a 50% red uction in pulmonary artery pressure, (4) O-2 administration to mildly hypox emic infants (SpO(2) 89%) caused a 50% decrease in airway resistance, and ( 5) low-flow oxygen reduced the frequency of intermittent hypoxemic episodes , even in infants who had Values of greater than or equal to 90% at rest. B ased on these data, it is recommended that oxygen therapy should be conside red in infants whose baseline SpO(2) is <93%, and that SpO(2) should be mai ntained at greater than or equal to 95% when infants are managed at home. P ediatr Pulmonol. 1998; 26:424-428. (C) 1998 Wiley-Liss, Inc.