Quality standard

Quality statement 4: Oxygen saturation

Quality statement 4: Oxygen saturation

Quality statement

Preterm babies have a target oxygen saturation of 91% to 95% after stabilisation.

Rationale

Aiming for an oxygen saturation level of between 91% and 95% can reduce mortality, particularly in babies born very preterm (between 28 weeks and 31 weeks plus 6 days) and extremely preterm (under 28 weeks). Setting a target oxygen saturation level of less than 91% increases the risk of mortality and morbidity.

Quality measures

Structure

Evidence of local arrangements to ensure that preterm babies have a target oxygen saturation of 91% to 95% after stabilisation.

Data source: Local data collection, for example, audits of oxygen administration protocols.

Process

Proportion of preterm babies who have a target oxygen saturation set at between 91% and 95% after stabilisation.

Numerator – the number in the denominator who have a target oxygen saturation between 91% and 95%.

Denominator – the number of preterm babies receiving oxygen after stabilisation.

Data source: Local data collection, for example, audits of patient records.

Outcome

Mortality rates in preterm babies.

Data source: Local data collection, for example, audits of neonatal mortality rates. The National Neonatal Audit Programme (NNAP) collects data on mortality in preterm babies, which will be published by local neonatal networks from 2020.

What the quality statement means for different audiences

Service providers (such as neonatal units, including special care units, local neonatal units and neonatal intensive care units) ensure that systems are in place for preterm babies to have a target saturation level of 91% to 95%. They ensure that healthcare professionals are aware of this target.

Healthcare professionals (such as specialist neonatal nurses, specialist neonatal consultants and other paediatric specialists working with babies born preterm) ensure that oxygen saturation targets for preterm babies are between 91% and 95%. They monitor this using continuous pulse oximetry, supplemented by arterial sampling if clinically indicated.

Commissioners (NHS England) ensure that they commission services that specify target oxygen saturation levels of 91% to 95% in preterm babies.

Preterm babies have the amount of oxygen in their blood (oxygen saturation) monitored, with the aim of achieving a safe level (between 91% and 95%).

Definitions of terms used in this quality statement

Stabilisation

Facilitating and supporting a smooth transition from fetal to neonatal life. The process involves careful assessment of heart rate, colour (oxygenation) and breathing, and providing appropriate interventions where indicated.

Be aware that some pulse oximeters can underestimate or overestimate oxygen saturation levels, especially if the saturation level is borderline. Overestimation has been reported in people with dark skin. See also the NHS England Patient Safety Alert on the risk of harm from inappropriate placement of pulse oximeter probes. [NICE's guideline on specialist neonatal respiratory care for babies born preterm, recommendation 1.4.2 and terms used in this guideline section]