Pulse oximetry in very low birth weight infants: can oxygen saturation be maintained in the desired range?

Laptook, Abbot R.; Salhab, Walid A.; Allen, James; Saha, Shampa; Walsh, Michele C.

doi:10.1038/sj.jp.7211500

Cited by 82 publications

(66 citation statements)

References 19 publications

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“…We were unable to analyze bronchopulmonary dysplasia, or other elements of care process examined in SUPPORT (ie, targeted ventilation strategy and oxygen saturation), which were not included in the PMH databases. In addition, target oxygen saturation values of 88% to 94%, a PMH NICU policy since May 2002, 37 …”

Section: Discussionmentioning

confidence: 99%

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Participating in a trial may affect processes of care by participating physicians; however, no study has assessed whether it affects processes of care for nonenrolled patients.WHAT THIS STUDY ADDS: Participation in a trial may affect processes of care for nonenrolled patients, even when care providers participating in or familiar with the trial protocol are unaware that data on nonenrolled patients are being collected for a study. weeks' gestational age (GA) were randomized in the delivery room (DR) to endotracheal intubation or nasal continuous positive airway pressure. We hypothesized that DR intubation could change in nonenrolled patients at PMH and that the change would be larger than in comparable centers not participating in the trial. METHODS:The PMH Cohort included eligible but nonenrolled neonates of 24 0/7 to 27 6/7 weeks (primary) and noneligible neonates of 28 to 34 6/7 weeks (confirmatory). A subset (24 0/7 -29 6/7 weeks) of that cohort was compared with a contemporaneous cohort born in centers participating in the Vermont Oxford Network (VON). We used a Poisson regression model to obtain adjusted relative risks (RRs) of DR intubation (during/after SUPPORT versus before SUPPORT) for PMH and for VON along with the ratio of these RRs. RESULTS:In the PMH cohort (n = 3527), the proportion of DR intubation decreased during/after SUPPORT in the lower GA group (adjusted RR 0.76, 95% confidence interval [CI] 0.59-0.96) and the upper GA group (adjusted RR 0.57, 95% CI 0.46-0.70). Compared with the RR for DR intubation in VON, the RR at PMH was smaller in the lower (ratio of RR 0.76, 95% CI 0.65-0.87) and the upper GA group (ratio of RR 0.52, 95% CI 0.39-0.68).CONCLUSIONS: A center' s participation in an unblinded randomized trial may affect process of care of nonenrolled patients. Pediatrics 2013;132:e960-e970 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

et al. 2013

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“…In Colombia, SpO 2 was within or above the target 34 and 55% of the time, respectively 21. Effects of training nurses to target SpO 2 ranges are varied 23, 27…”

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confidence: 99%

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Morgan

Maina

Waiyego

et al. 2017

J Paediatrics Child Health

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AimThere are 2.7 million neonatal deaths annually, 75% of which occur in sub‐Saharan Africa and South Asia. Effective treatment of hypoxaemia through tailored oxygen therapy could reduce neonatal mortality and prevent oxygen toxicity.MethodsWe undertook a two‐part prospective study of neonates admitted to a neonatal unit in Nairobi, Kenya, between January and December 2015. We determined the prevalence of hypoxaemia and explored associations of clinical risk factors and signs of respiratory distress with hypoxaemia and mortality. After staff training on oxygen saturation (SpO2) target ranges, we enrolled a consecutive sample of neonates admitted for oxygen and measured SpO2 at 0, 6, 12, 18 and 24 h post‐admission. We estimated the proportion of neonates outside the target range (≥34 weeks: ≥92%; <34 weeks: 89–93%) with 95% confidence intervals (CIs).ResultsA total of 477 neonates were enrolled. Prevalence of hypoxaemia was 29.2%. Retractions (odds ratio (OR) 2.83, 95% CI 1.47–5.47), nasal flaring (OR 2.68, 95% CI 1.51–4.75), and grunting (OR 2.47, 95% CI 1.27–4.80) were significantly associated with hypoxaemia. Nasal flaring (OR 2.85, 95% CI 1.25–6.54), and hypoxaemia (OR 3.06, 95% CI 1.54–6.07) were significantly associated with mortality; 64% of neonates receiving oxygen were out of range at ≥2 time points and 43% at ≥3 time points.ConclusionThere is a high prevalence of hypoxaemia at admission and a strong association between hypoxaemia and mortality in this Kenyan neonatal unit. Many neonates had out of range SpO2 values while receiving oxygen. Further research is needed to test strategies aimed at improving the accuracy of oxygen provision in low‐resource settings.

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“…12 Studies that compare actual versus intended pulse oxygen saturation in very preterm infants have shown that poor compliance with the desired range of oxygen saturation target values and with alarm limits for pulse oximetry is an important and common problem in NICUs worldwide. [13][14][15][16][17] However, our neonatal team has maintained COT study participants within the intended pulse oximetry alarm limits between 68 and 79% of the time. Although our teams' performance is among the best of all neonatal units participating in the COT study, it needs to be highlighted that we only measured compliance during the first 3 days of life while infants were receiving supplemental oxygen.…”

Section: /41mentioning

confidence: 99%

Nurses’ compliance with alarm limits for pulse oximetry: qualitative study

et al. 2009

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Objective: Monthly audits for the multicenter Canadian Oxygen Trial have shown that our neonatal team has consistently maintained study participants within the intended pulse oximetry alarm limits between 68 and 79% of the time during the first 3 days of life while infants were receiving supplemental oxygen. This good performance prompted us to explore our nurses' perceptions of what makes them compliant with alarm limits for pulse oximetry in preterm infants.Study Design: The local neonatal research nurse interviewed all 41 staff nurses in the neonatal intensive care unit at the University Children's Hospital in Tuebingen, Germany, for this qualitative study.Result: Nurses identified education (22/41), prompt response to alarms (22/41), a favorable patient-to-staff ratio (18/41), root cause analysis at the bedside (15/41), and the high priority given to control of oxygen therapy in the department (14/41) as the five most important determinants of their good compliance.Conclusion: These findings may be useful for other neonatal teams who struggle to improve their compliance with alarm limits for pulse oximetry.

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Pulse oximetry in very low birth weight infants: can oxygen saturation be maintained in the desired range?

Cited by 82 publications

References 19 publications

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

Change in Care Among Nonenrolled Patients During and After a Randomized Trial

Pulse oximetry values of neonates admitted for care and receiving routine oxygen therapy at a resource‐limited hospital in Kenya

Nurses’ compliance with alarm limits for pulse oximetry: qualitative study

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