Transcutaneous Oxygen Monitoring in Premature Infants

Lynsey Keep, RN
NICU incubator

Transcutaneous oxygen monitoring in premature infants is necessary to establish whether they are receiving safe and correct levels of supplementary oxygen.

The Need for Oxygen Monitoring

When an infant is born prematurely, due to underdeveloped lungs and other vital organs, it is usually necessary to administer supplementary oxygen. It is common and safe practice to measure accurately the levels of oxygen in the infant's blood.

Oxygen levels are often low in the premature infant. Because levels cannot be detected by visual observation alone, a more detailed recording is gained by placing a probe on either the hand or foot of the infant, called transcutaneous monitoring. The need for close oxygen monitoring of the infant is necessary, with or without the additional oxygen, ensuring he or she receives safe levels.

The Purpose of Transcutaneous Oxygen Monitoring in Premature Infants

Trancutaneous oxygen monitoring in premature infants measures levels of oxygen present in the blood stream. The levels are calculated by percentage, with 100 percent being the most desirable level. Highly skilled neonatal nurses and physicians observe, and act upon, any recorded drops in oxygen levels. Transcutaneous monitoring equipment is designed with elaborate in-built alarms to detect when the infant's oxygen levels are dangerously low.

Accuracy in Monitoring Oxygen Levels

As well as being hugely beneficial, the high-tech accuracy that such equipment offers can also lend itself to being over sensitive. The transcutaneous monitors are delicate and can trigger an alarm by simple movement alone. They most accurately record when the detection probe is sufficiently attached to the infant, and even better if the infant is lying still to avoid interference from external influences.

A true reading is obtained when the conditions mentioned above apply. Infants, even premature ones, move about, and this can cause frequent interference and subsequent alarming of monitoring equipment. Neonatal nurses are familiar with this type of equipment and are able to judge quickly whether the alarm is something that requires medical intervention. It is essential that action not be taken simply because of an alarm being triggered. The cause of the alarm must be established first or oxygen could be increased for no reason.

Low Oxygen Levels

Transcutaneous oxygen monitoring in premature infants is a simple, yet potentially life-saving clinical procedure. When a monitor records low oxygen levels, nursing and medical staff act quickly, by increasing the administered oxygen flow to the infant. The results of this action are rapid, and within seconds, the transcutaneous monitor will display readings that are more desirable.

Immediate action is crucial when the monitoring equipment indicates the infants oxygen levels have dropped. If an infant does not receive adequate oxygen supply, he or she runs a risk either in the long or short term of experiencing serious respiratory complications. The more stable and developed a premature infant is, the more likely he or she is able to cope with occasional drops in oxygen supply.

For an infant born significantly pre-term (less than 28 weeks), the need for oxygen therapy is crucial. Reduced levels can contribute to a lesser chance of survival.

Stopping Transcutaneous Monitoring

A premature infant will receive transcutaneous oxygen monitoring for the greater part of her stay in the neonatal intensive care unit (NICU). When an infant no longer requires supplemented oxygen, or background monitoring, she is commonly transferred to a standard pediatric unit, or better still, sent home.

Monitoring stops when the neonatal team can be sure that acceptable oxygen levels are being sustained, without the need to supplement it. It is common practice to keep an infant in the unit for a few days without monitoring equipment, to ensure that this safe level has been achieved. This also offers significant reassurance to concerned parents.

Home Oxygen Monitoring

On some occasions, it is necessary for a baby to go home with supplementary oxygen therapy. Parents spend several weeks learning how to administer oxygen safely and measure levels accurately.

Portable transcutaneous monitoring equipment is provided so that parents can intermittently observe oxygen levels of their infant. The alternative to this advanced monitoring, is an apnea alarm, which is a more common measure parents use to ensure the infant is breathing. It is only acceptable to send an infant home on this therapy when there is no immediate risk to life if oxygen levels drop.

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Transcutaneous Oxygen Monitoring in Premature Infants