• Usual unit target range SpO₂ 91–95% for preterm babies <36 weeks’ corrected gestational age, who are breathing on supplemental oxygen
• Prescribe oxygen on baby’s drug chart specifying target range
• Alternative saturation targets or strategy may be specified for babies with congenital heart disease or those at risk of persistent pulmonary hypertension

Setting alarm limits

General principles

Monitor

• Assess monitor trace and baby before increasing inspired oxygen 
• If intubated and need for increasing oxygen, check for DOPE:
  
  • displaced endotracheal tube (D)
  • presence of secretions or blood that may be causing obstruction or kinked ET Tube (O)
  • pneumothorax (P)
  • equipment failure or need for change in ventilator support (E)

Adjust inspired oxygen

• Change inspired oxygen in increments of 1–3% at a time except before procedures or with significant desaturations below 70%. In these circumstances, see below

• Avoid titrating target saturation with large and frequent increases and decreases in inspired oxygen 

  • wide fluctuations increase risk of retinopathy of prematurity in preterm babies

  • small frequent tweaking of inspired oxygen by 1–3% between 40–50% oxygen is much better than intermittently swinging between 30–80% oxygen to achieve same target range

  • use of OxyGenie™ technology for oxygen saturation targeting, if using SLE 6000 ventilators

Specific circumstances

High alarm

• Silence alarm and observe for an alarm cycle (3 min)
• If alarm still sounding after a cycle, decrease inspired oxygen by 1–3% 
• Continue reducing inspired oxygen by 1–3% every alarm cycle until saturation stable in desired range

Low alarm

• Silence alarm and observe 
• Assess waveform and heart rate
• Baby: check for DOPE and manage appropriately
• If desaturation persists after above checks, increase inspired oxygen by 1–3% for moderate desaturation (≥70%)
  
  • significant desaturations (<70%), double baseline inspired oxygen (increase by ≥20%) until SpO₂ increases to 90%, then wean rapidly to within 3% of baseline inspired oxygen

Handling or procedures

• If history of significant desaturation with handling or procedures, increase inspired oxygen by 5–10% before handling or procedure
  
  • may require ventilator changes to increase mean airway pressure (discuss with middle grade/ANNP)
• After procedure, once SpO₂ stabilises, wean inspired oxygen rapidly to baseline 

Labile cases

• Some sick babies will be particularly labile and it is challenging to maintain SpO₂ in target range. In rare cases, individualised adjustments to alarm settings may be necessary after discussion with medical team