An Altitude Adjustment: Implementing a Clinical Practice Guideline in the Newborn Nursery at Moderate Altitude

Abstract

Practice Problem: All infants undergo many changes at birth, but for some, the transition from intrauterine to extrauterine life presents more of a challenge, especially at altitude. Despite continuing research, neonatal prescribing guidelines for oxygen therapy remain ambiguous. PICOT: For term and late preterm infants requiring oxygen beyond transition, does a clinical practice guideline compared to practice without a guideline, provide consistent, evidence-based care, support the mother-infant dyad, and impact nursing perceptions over a six-week pilot period? Evidence: Birth at moderate altitude presents the newly born with less oxygen than those delivered at sea level. Several studies have assessed the differences and make recommendations for modifying acceptable saturations or compensating with a small amount of nasal cannula oxygen (the “altitude adjustment”), but recommend further study before broad application. Intervention: A consensus guideline for oxygen administration, weaning, and echocardiogram for indeterminate CCHD screens was created and implemented to facilitate care and practice consistency for patient safety and maintain the mother/infant dyad in a unique nursery setting. Outcome: After implementation, two infants demonstrated persistent pulmonary hypertension of the newborn, were treated with supplemental oxygen, and had normal ECHOs for age at discharge. These babies may have worsened without supportive treatment or required rehospitalization, demonstrating clinical significance for the pathway in the guideline. Conclusion: A shared-practice guideline for infants requiring supplemental oxygen following delivery was the focus of this EBP project. Evidence supports practice consistency by using guidelines and pathways across many disciplines, and engaging nurses in bringing evidence-based practice to the bedside improves patient outcomes.