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Published online May 1, 2008
PEDIATRICS Vol. 121 No. 5 May 2008, pp. e1039-e1046 (doi:10.1542/peds.2007-2257)
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ARTICLE

Nurse Opinions and Pulse Oximeter Saturation Target Limits for Preterm Infants

Tuyet-Hang Nghiem, MDa, James I. Hagadorn, MD, MSb, Norma Terrin, PhDc, Sally Syke, RN, BSNd, Brenda MacKinnon, RNCd, Cynthia H. Cole, MD, MPHe

a Division of Neonatology, Children's Hospital, Boston, Massachusetts
b Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut
c Institute for Clinical Research and Health Policy Studies
d Division of Newborn Medicine, Tufts–New England Medical Center, Boston, Massachusetts
e Department of Neonatology, Beth Israel-Deaconess Medical Center, Boston, Massachusetts

OBJECTIVE. The objectives of this study were to compare pulse oximeter saturation limits targeted by nurses for extremely preterm infants during routine care with nurse opinions regarding appropriate pulse oximeter saturation limits and with policy-specified pulse oximeter saturation limits and to identify factors that influence pulse oximeter saturation limits targeted by nurses.

METHODS. We surveyed nurses in US NICUs with neonatal-perinatal fellowships in 2004. Data collected included pulse oximeter saturation limits targeted by nurses and by NICU policy when present, nurses' opinions about appropriate pulse oximeter saturation limits, and NICU and nurse characteristics. Factors associated with pulse oximeter saturation limits targeted by nurses were identified with hierarchical linear modeling.

RESULTS. Among those eligible, 2805 (45%) nurses in 59 (60%) NICUs responded. Forty (68%) of 59 NICUs had a policy that specified a pulse oximeter saturation target range for extremely preterm infants. Among 1957 nurses at NICUs with policies, 540 (28%) accurately identified the upper and lower limits of their NICU's policy and also targeted these values in practice. NICU-specific SDs for individual nurse target limits were less at NICUs with versus without a policy for both upper and lower limits. Hierarchical linear modeling identified presence of pulse oximeter saturation policy, NICU-specific nurse group opinion, and individual nurse opinion as factors significantly associated with individual pulse oximeter saturation target limits. For each percentage point increase in individual opinion upper limit, the individual target upper limit increased by 0.41 percentage point at NICUs with a policy compared with 0.6 percentage point at NICUs with no policy.

CONCLUSIONS. Presence of policy-specified pulse oximeter saturation limits, nurse group opinion, and individual nurse opinion were independently associated with individual nurse pulse oximeter saturation target limits during routine care of extremely preterm infants. The presence of a policy reduced the influence of individual nurse opinion on targeted pulse oximeter saturation limits and reduced variation among nurse target limits within NICUs.

Key Words: oxygen saturation • prematurity • policy • oxygenation • pulse oximetry • NICU

Abbreviations: EPI—extremely preterm infant • SpO2—pulse oximeter oxygen saturation

Accepted Nov 1, 2007.


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