Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity: The Pediatrix Experience

Ellsbury, Dan L.; Ursprung, Robert

doi:10.1016/j.clp.2010.01.012

Cited by 19 publications

(13 citation statements)

References 45 publications

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“…Starting in 2008, the Japanese Red Cross Sendai Hospital began using PROP for extremely preterm infants. Similar to many previous studies (Sears et al 2009;Ellsbury and Ursprung 2010), PROP has been found to significantly reduce the incidence of severe ROP without increasing adverse outcomes.…”

Section: Discussionsupporting

confidence: 73%

Low Incidence of Sight-Threatening Retinopathy of Prematurity in Infants Born Before 28 Weeks Gestation at a Neonatal Intensive Care Unit in Japan

Aikawa

Noro

2013

Tohoku J. Exp. Med.

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Improvement in neonatal care has led to increased survival rates of very premature infants. Accordingly, there are now more extremely preterm infants who are at risk of developing retinopathy of prematurity (ROP). ROP is a disorder of low birth-weight preterm infants and may lead to blindness. However, the prevalence of ROP varies globally, depending on different neonatal and ophthalmic care. Therefore, we studied the incidence and progression of ROP in extremely preterm infants in Japan. In addition, we investigated the characteristics and the clinical courses of the infants who progressed to sight-threatening ROP. A total of 3,154 infants were born at the Japanese Red Cross Sendai Hospital between 2009 and 2011, including 53 live-born infants born before 28 weeks' gestation. Two extremely preterm infants died before the first ROP examination. Among the survived 51 infants (the birth-weight ranged from 309 to 1,354 g, mean 779 g), 36 infants (70.6%) developed ROP: 18 infants with mild ROP and 18 infants with severe ROP. Eight out of the 51 infants (15.7%) underwent laser treatment. None of the infants born at older than 27 weeks 0 day of gestation required any treatment for ROP. In conclusion, most of extremely preterm infants develop some degree of ROP. However, in the majority of these infants the ROP never progressed beyond mild disease and resolved spontaneously without treatment. Sight-threatening ROP was rare. The present study clarifies the natural history of ROP in extremely preterm infants with active perinatal care.

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Section: Discussionsupporting

confidence: 73%

Low Incidence of Sight-Threatening Retinopathy of Prematurity in Infants Born Before 28 Weeks Gestation at a Neonatal Intensive Care Unit in Japan

Aikawa

Noro

2013

Tohoku J. Exp. Med.

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“…However, 3 trials reported an increased risk of death at hospital discharge in infants randomized to the lower SpO 2 target [13,14]. A Cochrane review of all 5 trials, comprising nearly 5,000 infants, confirmed an increased risk of death at [18][19][20][21][22][23][24] [8]. It is likely that concerns about increasing the risk of ROP is one reason why not all NICUs have adopted higher SpO 2 targets [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, Switzerland and the ANZNN had the lowest rates of ROP treatment in our previous study, but here they had respectively relatively wide (7.6%) and narrow (4.4%) median target ranges [4]. How best to achieve compliance with target ranges remains controversial, but having set alarm limits and feedback on compliance are likely to be important [24,25].…”

Section: Discussionmentioning

confidence: 99%

Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey

et al. 2018

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Background: Rates of retinopathy of prematurity (ROP) and ROP treatment vary between neonatal intensive care units (NICUs). Neonatal care practices, including oxygen saturation (SpO₂) targets and criteria for the screening and treatment of ROP, are potential contributing factors to the variations. Objectives: To survey variations in SpO₂ targets in 2015 (and whether there had been recent changes) and criteria for ROP screening and treatment across the networks of the International Network for Evaluating Outcomes in Neonates (iNeo). Methods: Online prepiloted questionnaires on treatment practices for preterm infants were sent to the directors of 390 NICUs in 10 collaborating iNeo networks. Nine questions were asked and the results were summarized and compared. Results: Overall, 329/390 (84%) NICUs responded, and a majority (60%) recently made changes in upper and lower SpO₂ target limits, with the median set higher than previously by 2–3% in 8 of 10 networks. After the changes, fewer NICUs (15 vs. 28%) set an upper SpO₂ target limit > 95% and fewer (3 vs. 5%) a lower limit < 85%. There were variations in ROP screening criteria, and only in the Swedish network did all NICUs follow a single guideline. The initial retinal examination was carried out by an ophthalmologist in all but 6 NICUs, and retinal photography was used in 20% but most commonly as an adjunct to indirect ophthalmoscopy. Conclusions: There is considerable variation in SpO₂ targets and ROP screening and treatment criteria, both within networks and between countries.

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“…The program built on our previous QI successes in improving growth and reducing retinopathy of prematurity (ROP). 25,26 Participation was not mandated, but was strongly encouraged. A key theme of the intervention was a flexible and adaptable approach to improving care within the context of the individual NICU's microsystem.…”

Section: Engagement Of Practicesmentioning

confidence: 99%

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

Ellsbury¹,

Clark²,

Ursprung³

et al. 2016

Pediatrics

Self Cite

113

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BACKGROUND AND OBJECTIVE: Despite advances in neonatal medicine, infants requiring neonatal intensive care continue to experience substantial morbidity and mortality. The purpose of this initiative was to generate large-scale simultaneous improvements in multiple domains of care in a large neonatal network through a program called the “100,000 Babies Campaign.” METHODS: Key drivers of neonatal morbidity and mortality were identified. A system for retrospective morbidity and mortality review was used to identify problem areas for project prioritization. NICU system analysis and staff surveys were used to facilitate reengineering of NICU systems in 5 key driver areas. Electronic health record–based automated data collection and reporting were used. A quality improvement infrastructure using the Kotter organizational change model was developed to support the program. RESULTS: From 2007 to 2013, data on 422 877 infants, including a subset with birth weight of 501 to 1500 g (n = 58 555) were analyzed. Key driver processes (human milk feeding, medication use, ventilator days, admission temperature) all improved (P < .0001). Mortality, necrotizing enterocolitis, retinopathy of prematurity, bacteremia after 3 days of life, and catheter-associated infection decreased. Survival without significant morbidity (necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, oxygen use at 36 weeks’ gestation) improved. CONCLUSIONS: Implementation of a multifaceted quality improvement program that incorporated organizational change theory and automated electronic health record–based data collection and reporting program resulted in major simultaneous improvements in key neonatal processes and outcomes.

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Comprehensive Oxygen Management for the Prevention of Retinopathy of Prematurity: The Pediatrix Experience

Cited by 19 publications

References 45 publications

Low Incidence of Sight-Threatening Retinopathy of Prematurity in Infants Born Before 28 Weeks Gestation at a Neonatal Intensive Care Unit in Japan

Low Incidence of Sight-Threatening Retinopathy of Prematurity in Infants Born Before 28 Weeks Gestation at a Neonatal Intensive Care Unit in Japan

Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey

A Multifaceted Approach to Improving Outcomes in the NICU: The Pediatrix 100 000 Babies Campaign

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