Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context

Abstract

ObjectiveTo evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting.Design and settingProspective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO2 monitoring.PatientsWe recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period.Main outcome measuresProportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO2 range of 90%–95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%–100%.ResultsPreterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO2 range of 90%–95%. They spent 75.0% (63.6–81.1) of time above 95%, and 2.7% (1.7–5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%–100%, and 0.9% (0.3–1.4) of time below 85%. Guidelines recommended SpO2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively.ConclusionsTo better maintain SpO2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO2 5.3 times per day appears suitable.

Oxygen systems and quality of care for children with pneumonia, malaria and diarrhoea: Analysis of a stepped-wedge trial in Nigeria

“…The Nigeria Oxygen Implementation program implemented and evaluated improved oxygen systems in 12 secondary health facilities in south-west Nigeria. Results are published elsewhere [5,[16][17][18][19][20][21][22]. We found that the introduction of pulse oximetry and improved oxygen systems contributed to marked improvements in pulse oximetry and oxygen practices and was associated with reduced risk of death for children admitted with pneumonia, but not other illnesses [5].…”

Nigerian neonatologists perception and experience with retinopathy of prematurity

“… 3 , 26 , 27 In the last 2-3 year however, routine screening is now taking place in some centers. 8 , 15 , 28 , 29 Though only 4 of the neonatologists that responded as shown in this paper were involved in ROP screening at the time of writing this article ( Table 5 ).…”

“…In a study looking at its use in low resource settings like Nigeria where it may not be available for each baby, it is advocated to at least monitor them more than 4.7 times a day to be able to better evenly maintain their SpO2. 29 …”

“…In a study looking at its use in low resource settings like Nigeria where it may not be available for each baby, it is advocated to at least monitor them more than 4.7 times a day to be able to better evenly maintain their SpO2. 29 Several neonatologists reported not to have had a case of ROP in their practice, this is not unexpected because screening was likely not done, leukocoria which is the only 'visible' sign of ROP only develops well after discharge from SCBUs and many surviving premature infants who are often referred from places far away from the hospitals are already lost to follow up only to present later in infancy to the eye clinics (not to pediatric clinics in most cases) with vision problems. The neonatal unit may not get the information about the visual status of the children unless caregivers vigorously make attempts to attend follow up (a rarity in developing countries).…”

A national retrospective review of neonatal critical care transfers in dedicated critical care transport services in the private sector

“…It is encouraging to note that almost all neonates had continuous monitoring attached, with pulse oximetry being the most common modality. Pulse oximetry in particular plays an important role in avoiding the deleterious effects of hyperoxia, [15,16] such as retinopathy, bronchopulmonary dysplasia and complicating ductal-dependent CHDs. Vascular access and mechanical ventilation were also common attachments.…”