Reference Ranges for Arterial Oxygen Saturation, Heart Rate, and Cerebral Oxygen Saturation during Immediate Postnatal Transition in Neonates Born Extremely or Very Preterm

Abstract

Objective: To define percentile charts for arterial oxygen saturation (SpO₂), heart rate (HR), and cerebral oxygen saturation (crSO₂) during the first 15 minutes after birth in neonates born very or extremely preterm and with favorable outcome.

Study design: We conducted a secondary-outcome analysis of neonates born preterm included in the Cerebral regional tissue Oxygen Saturation to Guide Oxygen Delivery in preterm neonates during immediate transition after birth III (COSGOD III) trial with visible cerebral oximetry measurements and with favorable outcome, defined as survival without cerebral injuries until term age. We excluded infants with inflammatory morbidities within the first week after birth. SpO₂ was obtained by pulse oximetry, and electrocardiogram or pulse oximetry were used for measurement of HR. crSO₂ was assessed with near-infrared spectroscopy. Measurements were performed during the first 15 minutes after birth. Percentile charts (10th to 90th centile) were defined for each minute.

Results: A total of 207 neonates born preterm with a gestational age of 29.7 (23.9-31.9) weeks and a birth weight of 1200 (378-2320) g were eligible for analyses. The 10th percentile of SpO₂ at minute 2, 5, 10, and 15 was 32%, 52%, 83%, and 85%, respectively. The 10th percentile of HR at minute 2, 5, 10, and 15 was 70, 109, 126, and 134 beats/min, respectively. The 10th percentile of crSO₂ at minute 2, 5, 20, and 15 was 15%, 27%, 59%, and 63%, respectively.

Conclusions: This study provides new centile charts for SpO₂, HR, and crSO₂ for neonates born extremely or very preterm with favorable outcome. Implementing these centiles in guiding interventions during the stabilization process after birth might help to more accurately target oxygenation during postnatal transition period.

Keywords: arterial oxygen saturation; centile charts; cerebral oxygen saturation; heart rate; immediate neonatal transition; neonates born preterm; percentiles; reference ranges.