Kaiser Permanente North California, 1640, Eureka Rd, Roseville, CA 95661, USA.
Department of Pediatrics, SIGMA Hospital, P8/D, Kamakshi Hospital Road, Mysore 570009, India.
Early Hum Dev. 2024 Dec;199:106134. doi: 10.1016/j.earlhumdev.2024.106134. Epub 2024 Oct 28.
Optimal oxygenation requires the delivery of oxygen to meet tissue metabolic demands while minimizing hypoxic pulmonary vasoconstriction and oxygen toxicity. Oxygen saturation by pulse oximetry (SpO) is a continuous, non-invasive method for monitoring oxygenation. The optimal SpO target varies during pregnancy and neonatal period. Maternal SpO should ideally be ≥95 % to ensure adequate fetal oxygenation. Term neonates can be resuscitated with an initial oxygen concentration of 21 %, while moderately preterm infants require 21-30 %. Extremely preterm infants may need higher FiO, followed by titration to desired SpO targets. During the NICU course, extremely preterm infants managed with an 85-89 % SpO target compared to 90-94 % are associated with a reduced incidence of severe retinopathy of prematurity (ROP) requiring treatment, but with higher mortality. During the later stages of ROP progression, studies suggest that higher SpO targets may help limit progression. A target SpO of 90-95 % is generally reasonable for term infants with respiratory disease or pulmonary hypertension, with few exceptions such as severe acidosis, therapeutic hypothermia, and possibly dark skin pigmentation, where 93-98 % may be preferred. Infants with cyanotic heart disease and single-ventricle physiology have lower SpO targets to avoid pulmonary over-circulation. In low- and middle-income countries (LMICs), the scarcity of oxygen blenders and continuous monitoring may pose a challenge, increasing the risks of both hypoxia and hyperoxia, which can lead to mortality and ROP, respectively. Strategies to mitigate hyperoxia among preterm infants in LMICs are urgently needed to reduce the incidence of ROP.
优化氧合需要输送氧气以满足组织代谢需求，同时最大限度地减少低氧性肺血管收缩和氧毒性。脉搏血氧饱和度（SpO）通过脉搏血氧饱和度监测仪（SpO）进行连续、非侵入性监测。在妊娠和新生儿期，最佳 SpO 目标值有所不同。母体 SpO 理想情况下应≥95%，以确保胎儿充分氧合。足月儿可以用初始氧浓度 21%进行复苏，而中度早产儿需要 21-30%。极早产儿可能需要更高的 FiO，然后滴定至所需的 SpO 目标值。在新生儿重症监护病房（NICU）期间，与接受 90-94% SpO 目标值管理的极早产儿相比，接受 85-89% SpO 目标值管理的极早产儿发生需要治疗的严重早产儿视网膜病变（ROP）的发生率降低，但死亡率更高。在 ROP 进展的后期阶段，研究表明较高的 SpO 目标值可能有助于限制其进展。对于患有呼吸疾病或肺动脉高压的足月婴儿，一般认为 SpO 目标值为 90-95%是合理的，但存在少数例外情况，如严重酸中毒、治疗性低温以及可能的深色皮肤色素沉着，此时可能更倾向于 93-98%。患有紫绀型心脏病和单心室生理的婴儿需要较低的 SpO 目标值，以避免肺过度循环。在中低收入国家（LMICs），氧气混合器和持续监测的缺乏可能构成挑战，这增加了缺氧和高氧血症的风险，分别导致死亡率和 ROP。迫切需要在 LMICs 中制定早产儿低氧血症的缓解策略，以降低 ROP 的发生率。
