Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. 882-889 (doi:10.1542/peds.2007-0117)

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ARTICLE

Pulse Oxygen Saturation Levels and Arterial Oxygen Tension Values in Newborns Receiving Oxygen Therapy in the Neonatal Intensive Care Unit: Is 85% to 93% an Acceptable Range?

Armando Castillo, MD^a, Augusto Sola, MD^b, Hernando Baquero, MD^c, Freddy Neira, MD^c, Ramiro Alvis, MD^c, Richard Deulofeut, MD, MPH^d and Ann Critz, MD^a

^a Division of Neonatal-Perinatal Medicine, Emory University, Atlanta, Georgia
^b Mid-Atlantic Neonatology Associates and Atlantic Neonatal Research Institute, Morristown Memorial Hospital, Morristown, New Jersey
^c Department of Pediatrics, University of the North, Barranquilla, Colombia
^d Pediatrix Medical Group, Neonatology, Dallas, Texas

OBJECTIVE. Our aim was to define the relationship of PaO₂ and pulse oxygen saturation values during routine clinical practice and to evaluate whether pulse oxygen saturation values between 85% and 93% were associated with PaO₂ levels of <40 mmHg.

METHODS. Prospective comparison of PaO₂ and pulse oxygen saturation values in 7 NICUs at sea level in 2 countries was performed. The PaO₂ measurements were obtained from indwelling arterial catheters; simultaneous pulse oxygen saturation values were recorded if the pulse oxygen saturation values changed <1% before, during, and after the arterial gas sample was obtained.

RESULTS. We evaluated 976 paired PaO₂/pulse oxygen saturation values in 122 neonates. Of the 976 samples, 176 (18%) from infants breathing room air had a mean pulse oxygen saturation of 93.9 ± 4.3% and a median of 95.5%. The analysis of 800 samples from infants breathing supplemental oxygen revealed that, when pulse oxygen saturation values were 85% to 93%, the mean PaO₂ was 56 ± 14.7 mmHg and the median 54 mmHg. At this pulse oxygen saturation level, 86.8% of the samples had PaO₂ values of 40 to 80 mmHg, 8.6% had values of <40 mmHg, and 4.6% had values of >80 mmHg. When the pulse oxygen saturation values were >93%, the mean PaO₂ was 107.3 ± 59.3 mmHg and the median 91 mmHg. At this pulse oxygen saturation level, 39.5% of the samples had PaO₂ values of 40 to 80 mmHg and 59.5% had values of >80 mmHg.

CONCLUSIONS. High PaO₂ occurs very rarely in neonates breathing supplemental oxygen when their pulse oxygen saturation values are 85% to 93%. This pulse oxygen saturation range also is infrequently associated with low PaO₂ values. Pulse oxygen saturation values of >93% are frequently associated with PaO₂ values of >80 mmHg, which may be of risk for some newborns receiving supplemental oxygen.

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Key Words: oxygen therapy • pulse oxygen saturation • normoxemia • hypoxemia • hyperoxemia • oxygen arterial tension • newborns • oxyhemoglobin dissociation curve

Abbreviations: SpO₂—pulse oxygen saturation • P₅₀—partial pressure of a gas required to achieve 50% saturation • FIO₂—fraction of inspired oxygen

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Accepted Sep 17, 2007.

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