Assessing Oxygen Weaning Readiness in NICU Patients Using Oxygen Saturation Histograms: A Systematic Review

Weaning late preterm and term infants from respiratory support remains challenging because clinicians must balance the risks of hyperoxia and hypoxia while determining when room air trials and discharge are appropriate.Oxygen saturation histograms provide an objective method for evaluating oxygenation trends over time, but standardized approaches for neonatal intensive care unit (NICU) patients, particularly infants ≥34 weeks' gestation, remain limited.This systematic review evaluated whether oxygen saturation histogram patterns can predict readiness for room air trials or inform discharge decisions in NICU patients receiving nasal continuous positive airway pressure, high-flow nasal cannula, or low-flow nasal cannula oxygen therapy.Studies involving infants with major congenital anomalies, postmenstrual age greater than 42 weeks, or invasive mechanical ventilation, intubation, or tracheostomy extending beyond 36 weeks' postmenstrual age in the very low birth weight subgroup were excluded.A comprehensive literature search was conducted across multiple databases from July to December 2024, and two reviewers independently screened studies and assessed risk of bias using a modified Quality in Prognosis Studies (QUIPS) tool.Nine studies met the inclusion criteria.Across the available evidence, greater time within target oxygen saturation ranges was associated with readiness for oxygen weaning, whereas excessive time below or outside defined thresholds suggested the need for continued monitoring or respiratory support.However, study populations, saturation thresholds, monitoring durations, and outcome definitions varied substantially, preventing meta-analysis and limiting direct standardization.Oxygen saturation histograms appear promising as an adjunctive tool for guiding oxygen weaning and discharge decisions in NICU patients, but validated thresholds for late preterm and term infants are not yet established.Multicenter prospective studies using consistent histogram definitions, standardized room air trial criteria, and longterm outcome assessment are needed to support individualized and evidence-based respiratory care.