A survey of the optimal oxygen saturation targets in premature infants in the neonatal intensive care units of three tertiary care hospitals in Tshwane, South Africa

Background. An optimal oxygen saturation target for premature infants receiving supplemental oxygen, that aims to decrease morbidity and mortality, has been the aim of many studies worldwide. Recently, a saturation target of 91 - 95% was recommended by the NeOProM collaboration. Objective. To identify current practice and healthcare-worker knowledge regarding target oxygen saturation in preterm infants. Method. This cross-sectional descriptive study was conducted at three tertiary hospital neonatal units in Tshwane, South Africa. A web- based survey was administered to staff caring for premature infants. To confirm the reliability of the survey, a snapshot was conducted to assess actual practice in the neonatal units. Results. A total of 190 responses from the three neonatal units were analysed for the web-based survey. Overall, 56.3% of respondents indicated that a written standard operating procedure (SOP) for targeting oxygen saturation was in place. However, data analysis revealed that 43 different saturation target ranges were reported, with 90 - 95% being the most common. Approximately three-quarters of respondents indicated that supplemental oxygen may have harmful effects. Knowledge-based questions assessing the benefits and risks of targeting lower saturations (85 - 89%) were answered poorly. Snapshot data analysis revealed that 70.2% of infants were receiving oxygen, of which 81.2% received blended oxygen. The majority (61.2%) of these premature infants had saturations above 95%, with only 27.1% of infants’ snapshot saturations falling within the recommended range (91 - 95%). Conclusion. The large number of saturation target range responses that deviated from the SOP stipulated target, indicates that staff are not following an SOP for targeting oxygen saturation in premature infants. To ensure standardised care, we recommend that all three units ensure the availability of a written SOP and perform ongoing staff training.