Fluctuating O2 sats in a preemie

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Hi all! I am new to level III NICU nursing so also new to taking care of micropreemies. Took care of an ex-25 weeker the other day (now 29 wks) on NCPAP. I have never seen such wildly fluctuating O2 sats as this child, and it makes it so difficult to titrate the FiO2. I mean this kid will to within 10 seconds to the 30s, 50s, 70s, 90s. I'm not exaggerating. My question is, how is this even possible? It just seems like it can't be correct, but it's all the information we have to work with. Of course we rely on gases to know the infant's status, but they are only done every 24 hrs.

Any knowledge or even opinions?

Thanks!

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Specializes in ICU.

I feel like we see big fluctuations in sats more in kiddos with moderate/large PDAs, down to the 40s not uncommonly. Most of us don't adjust the FiO2 unless they really fall, or stay down (not going to go up for sats of 84 for 30 seconds, for example) or else you'll be dealing with having to titrate it right back down once they recover. Our babies below 32 weeks are allowed to sat 85-95 and we decrease FiO2 above 95. But I've only been a NICU nurse for a year, so maybe others have more suggestions. I love the micropreemies but I come home and hear the constant alarms for desats in my dreams....

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Yes, I generally ignore the fluctuations unless the kid stays down. My point is only that the sats fluctuate very quickly and by large numbers. Most babies I care for change their sats much more slowly unless they brady.

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Specializes in NICU, Infection Control.

If the monitor has a screen that shows the HR, RR, and Sats as a trend so you can look @ 2mins or so @ once, look for periodic breathing-that could be the reason you're seeing the fluctuations. Also, look @ the trend in relationship to feedings. If it's worse the hour after a feed, you've got reflux.

If the baby has an intermittent PDA, that complicates things, it may need to be fixed.

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Thanks! Baby is on continuous feeds. Pretty sure there was no PDA but I will have to double check when I get back to work. Thanks for the input!

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Specializes in NICU.

Preemies are notorious for desating all over the place. We had orders to wean above a certain pulse ox. limit; baby would be doing well until we reached a certain point. Some babies did well on Fi02 .23; decrease them to .21 Fi02 and they would repeatedly desat. If I had such an infant, I would check with on-call MD or APN to ask if order could be written to not decrease Fi02 below .23.

Also, check the baby's nasal prongs to make sure they are not obstructed with secretions. Do you use long-prong CPAP? Sometimes something simple like changing the CPAP prongs is all that was needed. Make sure prongs are inserted the correct distance.Also, gently suction nares and back of throat to make sure they are clear.

Also, since preemie was on continuous feeds, I would elevate the HOB to maximum level in Isolette or warmer. If that had already been done by previous nurse, I would add a couple of folded towels uinder the HOB to ^^ angle by another 10 degrees or so.

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Specializes in CDI Supervisor; Formerly NICU.

When the sats were in the 40s, 50s, 60s, what did the kid look like? Any color change? Was he squirming? Where was the pulse ox attached to the baby? Was the seal on the CPAP intact? Did the baby have boogers that needed to be suctioned?

I usually don't believe the sats when my babies are fluctuating so greatly unless I see signs ON THE BABY that they aren't oxigenated well enough. If the sats say 43 and the baby is pretty and pink, I just don't buy it so I always investigate the equipment.

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Specializes in NICU, Infection Control.

Bortaz is soo right--sometimes we forget whether we're nursing the baby or the machine!

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Does s/he have VSD? Sounds like cardiac issues like everyone else said.

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