[Present situation of oxygen therapy and retinopathy of prematurity management in premature infants in NICUs: a survey based on 16 tertiary class-one hospitals in the mainland of China]

Abstract

Objective: To investigate the present status of oxygen therapy and retinopathy of prematurity (ROP) management in premature infants in tertiary class-one hospitals of the mainland of China.

Methods: A non-informed inspection on oxygen therapy and ROP management in premature infants was carried out by experts in neonatal intensive care units (NICU) of 16 tertiary class-one hospitals in different areas of the mainland of China in Oct. 2010, and data were collected and analyzed.

Result: In 16 tertiary first-class hospitals, NICU had (113.0 ± 67.0) beds for newborn per unit, with hospital admission of (3596.6 ± 1609.8) newborns in 2009, among them (1030.5 ± 580.2) cases were premature infants, and (397.8 ± 237.1) cases had gestational age less than 34 weeks. Most hospitals obtained written informed consents before using oxygen for premature infants and 11 of them informed parents of all patients, while the lowest inform rate was only 22.06%. Indication for oxygen administration was abided strictly in all patients in 9 hospitals, but the lowest accordance rate to the indication was only 20%. All of the hospitals were equipped with central oxygen supply system, but only 8 hospitals were equipped with air-oxygen mixers, and 14 hospitals were equipped with oxygen concentration detectors. Incomplete records of oxygen therapy were found in 9 hospitals, and high oxygen saturation (> 95%) was found in more than 10% of infants who received oxygen therapy in 6 hospitals. High PaO2 (> 80 mm Hg, 1 mm Hg = 0.133 kPa) was found in more than 10% infants who received oxygen therapy in additional 3 hospitals. All of the NICUs had carried out ROP screening, but only 13 of them conducted it by themselves, and one still conducted it by direct ophthalmoscope. Of the 1023 medical records inspected randomly in 16 hospital, 612 (59.8%) had retinal examination records, and 69 were found to suffer from ROP, with the incidence rate of 11.27%, of them 7 threshold ROP cases were found with the incidence rate of 1.14%.Only 4 hospitals had carried out ROP treatment, of them 3 used laser therapy, and one used cryotherapy. The follow-up rates of ROP in premature infants after discharge were less than 50% in 8 hospitals.

Conclusion: Since the first guidance on oxygen therapy and ROP management was promulgated by the Ministry of Health in 2004, the situation of oxygen therapy and ROP management in tertiary first-class hospitals of China had made considerable improvement, most of hospitals could abide the guidance well without blindness were found during the inspection, but some hospitals still have problems to be solved, including oxygen therapy without informing, loose implementation of oxygen indication, insufficient oxygen therapy facilities, inadequate oxygen concentration monitoring, incomplete records, low screening rate and follow-up rate, as well as under-treatment.