Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

Askie, Lisa; Henderson‐Smart, David J; Ko, Henry

doi:10.1002/14651858.cd001077.pub2

Cited by 49 publications

(41 citation statements)

References 58 publications

(13 reference statements)

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“…Practices that directly affect mortality and morbidity include antenatal steroids [4], gentle resuscitation at delivery [5], careful oxygen delivery and monitoring [6,7], pain control [8], avoidance of sepsis and hypothermia [9], better nutrition [10] and supportive care [11]. There are many reasons why care may not be adequate in neonatal intensive care units (NICUs) in LMICs including very low nurse-to-infant ratios, inadequate equipment to blend, deliver and monitor oxygen, and the fact that care is often by nurse assistants who have had limited training.…”

Section: Introductionmentioning

confidence: 99%

Educating Neonatal Nurses in Brazil: A Before-and-After Study with Interrupted Time Series Analysis

Gilbert

Darlow

Zin³

et al. 2014

Neonatology

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Background: Preterm birth contributes significantly to infant mortality and morbidity, including blindness from retinopathy of prematurity (ROP). Access to intensive neonatal care is expanding in many countries, but care is not always optimal, one factor being that nursing is often by inadequately trained nurse assistants. Objective: The aim of this study was to evaluate whether an educational package for nurses improves a range of outcomes including survival rates and severe ROP in 5 neonatal units in Rio de Janeiro, Brazil. Methods: The study design included an uncontrolled before-and-after study in 5 units, with interrupted time series analysis. Participatory approaches were used to develop a self-administered educational package for control of pain, oxygenation, infection, nutrition, and temperature and to improve supportive care (‘POINTS of Care'). Educational materials and DVD clips were developed and training skills of nurse tutors were enhanced. There were two 1-year periods of data collection before and after a 3-month period of self-administration of the education package. Results: Overall, 74% of 401 nurses and nurse assistants were trained. A total of 679 and 563 infants were included in the pre- and post-training periods, respectively. Despite improvement in knowledge and nursing practices, such as the delivery and monitoring of oxygen, there was no change in survival (pre-training 80%, post-training 78.2%), severe ROP (1.6 vs. 2.8%), sepsis (11.3 vs. 12.3 cases per 1,000 infant days) or other outcomes. Outcomes worsened over the pre-intervention period but the change to an improvement after the intervention was not statistically significant. During the study period many trained staff left the units, but few were replaced. Conclusions: Future studies need to focus on barriers to implementation, team building, leadership and governance, as well as the acquisition of knowledge and skills.

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Section: Introductionmentioning

confidence: 99%

Educating Neonatal Nurses in Brazil: A Before-and-After Study with Interrupted Time Series Analysis

Gilbert

Darlow

Zin³

et al. 2014

Neonatology

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“…Restricting high, unregulated supplemental oxygen to preterm infants dramatically reduced RLF, although it also increased mortality and morbidity. 13,19,20 Today nurseries are still searching for the appropriate set of guidelines to minimize the risk of ROP/RLF while taking into consideration morbidities in other organs. It was with the ability to measure first transcutaneous oxygen in the 1980s and then oxygen saturation in the 1990s that an idea developed of what external, inspired oxygen translated to in the individual preterm infant.…”

Section: Reassessment Of Rop In the 1940s Since Technological Advancesmentioning

confidence: 99%

Effects of oxygen on the development and severity of retinopathy of prematurity

Hartnett

Lane

2013

Journal of American Association for Pediatric Ophthalmology and

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SUMMARY In 1942, when retinopathy of prematurity (ROP) first manifested as retrolental fibroplasia, the technology to monitor or regulate oxygen did not exist, and a fundus examination of preterm infants was not routinely performed. Supplemental, uncontrolled oxygen at birth has since been found to cause retrolental fibroplasia. At the same time, technological advances have made it possible to regulate oxygen and detect early forms of ROP. Nevertheless, despite our better understanding of ROP and ongoing investigations of supplemental therapeutic oxygen, including recent clinical trials (Surfactant, Positive Airway Pressure, Pulse Oximetry Randomized Trial [SUPPORT] and Benefits of Oxygen Saturation Targeting [BOOST]), the best oxygen profiles to reduce ROP risk while optimizing preterm infant health and development remain unknown. This article reviews major studies on oxygen use in preterm infants and the effects on the development of ROP.

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“…In extremely premature infants, the optimal oxygen saturation (SpO 2 ) target is unclear. [1][2][3][4] Excessive oxygen leads to oxygen toxicity; oxidative stress; [5][6][7][8][9] and causes damage to various organs including the lungs, 10,11 brain, 12,13 and retina. [14][15][16] In particular, early postnatal hyperoxia is a major risk factor for retinopathy of prematurity (ROP).…”

mentioning

confidence: 99%

Lower early postnatal oxygen saturation target and risk of ductus arteriosus closure failure

Inomata

Taniguchi

et al. 2016

Pediatrics International

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Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

Abstract: Analysis 1.4. Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 4 Vascular RLF (severe stages

Cited by 49 publications

References 58 publications

Educating Neonatal Nurses in Brazil: A Before-and-After Study with Interrupted Time Series Analysis

Educating Neonatal Nurses in Brazil: A Before-and-After Study with Interrupted Time Series Analysis

Effects of oxygen on the development and severity of retinopathy of prematurity

Lower early postnatal oxygen saturation target and risk of ductus arteriosus closure failure

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