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Multicenter Study
. 2019 Jun:209:17-22.e2.
doi: 10.1016/j.jpeds.2019.01.048. Epub 2019 Apr 5.

Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm

Elizabeth E Foglia  1 , Benjamin Carper  2 , Marie Gantz  2 , Sara B DeMauro  3 , Satyan Lakshminrusimha  4 , Michele Walsh  5 , Barbara Schmidt  3 ; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Multicenter Study

Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm

Elizabeth E Foglia et al. J Pediatr. 2019 Jun.

Abstract

Objective: To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO2) alarm limits on neonatal mortality and morbidity among infants born very preterm.

Study design: This was a retrospective cohort study of infants born very preterm in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Infants were classified based on treatment at a hospital with an SpO2 alarm policy change and study epoch (before vs after policy change). We used a generalized linear mixed model to determine the effect of hospital group and epoch on the primary outcomes of mortality and severe retinopathy of prematurity (ROP) and secondary outcomes of necrotizing enterocolitis, bronchopulmonary dysplasia, and any ROP.

Results: There were 3809 infants in 10 hospitals with an SpO2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO2 alarm settings. Mortality was lower in hospitals without a policy change (aOR 0.63; 95% CI 0.50-0.80) but did not differ between epochs in policy change hospitals. The odds of bronchopulmonary dysplasia were greater for hospitals with a policy change (aOR 1.65; 95% CI 1.36-2.00) but did not differ for hospitals without a policy change. Severe ROP and necrotizing enterocolitis did not differ between epochs for either group. The adjusted odds of any ROP were lower in recent years in both hospital groups.

Conclusions: Changing SpO2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.

Keywords: mortality; oxygen saturation; preterm; retinopathy of prematurity.

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Figures

Figure 1:
Figure 1:
Oxygen saturation (SpO2) alarm settings for hospitals with and without a policy change. For hospitals without a SpO2 alarm policy change, median alarm limits were 88% (lower limit) and 95% (upper limit). For hospitals with a policy change, original alarm settings, shown in X marks, had median values of 85% (lower limit) and 96% (upper limit). The revised alarm settings, shown in circles, had median values of 89% (lower limit) and 95% (upper limit). Original alarm settings are not shown for 2 hospitals in the SpO2 alarm policy change group: 1 hospital transitioned from no policy to an SpO2 alarm policy, and 1 hospital did not have record of the original SpO2 alarm settings.
Figure 2.
Figure 2.
Study Flow Diagram. NRN: Neonatal research network; SUPPORT: Surfactant Positive Pressure and Pulse Oximetry Randomized Trial
See this image and copyright information in PMC

Comment in

  • Reply.
    Foglia EE, Carper B, Gantz M, Schmidt B. Foglia EE, et al. J Pediatr. 2021 Feb;229:311. doi: 10.1016/j.jpeds.2020.11.006. Epub 2020 Nov 9. J Pediatr. 2021. PMID: 33181196 No abstract available.
  • Clarification of aOR calculation.
    Srivatsa B. Srivatsa B. J Pediatr. 2021 Feb;229:310-311. doi: 10.1016/j.jpeds.2020.11.005. Epub 2020 Nov 9. J Pediatr. 2021. PMID: 33181198 No abstract available.

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