Managing oxygen therapy in the NICU is a balancing act, as we try to avoid undesirable outcomes at both ends of the spectrum: retinopathy of prematurity and bronchopulmonary dysplasia caused by too much oxygen, and neurologic impairment and death caused by too little.1 Monitoring oxygen levels has become a critical component of routine neonatal care. A recent study aimed to determine the rate of compliance with unit guidelines for alarm limits for pulse oximetry in preterm infants on oxygen therapy. The target saturation range recommended in written hospital guidelines was 88% to 92%, with alarm limits set at 85% and 94%. Data, collected prospectively, revealed that the lower alarm limit for very preterm infants on supplemental oxygen was usually set correctly; however, the upper alarm limit was set too high the majority of the time. The percentage of times when both the upper and lower alarm limits were set correctly was only 22%, leaving at least 1 alarm limit set incorrectly 78% of the time. Compliance was somewhat better for those at greater risk of adverse outcomes (infants on assisted ventilation, higher inspired oxygen concentrations, and those requiring more frequent changes in inspired oxygen concentration).

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