Elizabeth E Foglia1, Benjamin Carper2, Marie Gantz2, Sara B DeMauro3, Satyan Lakshminrusimha4, Michele Walsh5, Barbara Schmidt3. 1. Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. Electronic address: foglia@email.chop.edu. 2. RTI International, Research Triangle Park, NC. 3. Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 4. Department of Pediatrics, University of California Davis, Sacramento, CA. 5. Case Western Reserve University, Cleveland, OH.
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.
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.
Authors: Jeffrey M Perlman; Jonathan Wyllie; John Kattwinkel; Dianne L Atkins; Leon Chameides; Jay P Goldsmith; Ruth Guinsburg; Mary Fran Hazinski; Colin Morley; Sam Richmond; Wendy M Simon; Nalini Singhal; Edgardo Szyld; Masanori Tamura; Sithembiso Velaphi Journal: Circulation Date: 2010-10-19 Impact factor: 29.690
Authors: Barbara Schmidt; Robin S Roberts; Robin K Whyte; Elizabeth V Asztalos; Christian Poets; Yacov Rabi; Alfonso Solimano; Harvey Nelson Journal: J Pediatr Date: 2014-06-25 Impact factor: 4.406
Authors: Ben J Stenson; William O Tarnow-Mordi; Brian A Darlow; John Simes; Edmund Juszczak; Lisa Askie; Malcolm Battin; Ursula Bowler; Roland Broadbent; Pamela Cairns; Peter Graham Davis; Sanjeev Deshpande; Mark Donoghoe; Lex Doyle; Brian W Fleck; Alpana Ghadge; Wendy Hague; Henry L Halliday; Michael Hewson; Andrew King; Adrienne Kirby; Neil Marlow; Michael Meyer; Colin Morley; Karen Simmer; Win Tin; Stephen P Wardle; Peter Brocklehurst Journal: N Engl J Med Date: 2013-05-05 Impact factor: 91.245
Authors: Barbara Schmidt; Robin K Whyte; Elizabeth V Asztalos; Diane Moddemann; Christian Poets; Yacov Rabi; Alfonso Solimano; Robin S Roberts Journal: JAMA Date: 2013-05-22 Impact factor: 56.272
Authors: Barbara J Stoll; Nellie I Hansen; Edward F Bell; Michele C Walsh; Waldemar A Carlo; Seetha Shankaran; Abbot R Laptook; Pablo J Sánchez; Krisa P Van Meurs; Myra Wyckoff; Abhik Das; Ellen C Hale; M Bethany Ball; Nancy S Newman; Kurt Schibler; Brenda B Poindexter; Kathleen A Kennedy; C Michael Cotten; Kristi L Watterberg; Carl T D'Angio; Sara B DeMauro; William E Truog; Uday Devaskar; Rosemary D Higgins Journal: JAMA Date: 2015-09-08 Impact factor: 56.272
Authors: Waldemar A Carlo; Neil N Finer; Michele C Walsh; Wade Rich; Marie G Gantz; Abbot R Laptook; Bradley A Yoder; Roger G Faix; Abhik Das; W Kenneth Poole; Kurt Schibler; Nancy S Newman; Namasivayam Ambalavanan; Ivan D Frantz; Anthony J Piazza; Pablo J Sánchez; Brenda H Morris; Nirupama Laroia; Dale L Phelps; Brenda B Poindexter; C Michael Cotten; Krisa P Van Meurs; Shahnaz Duara; Vivek Narendran; Beena G Sood; T Michael O'Shea; Edward F Bell; Richard A Ehrenkranz; Kristi L Watterberg; Rosemary D Higgins Journal: N Engl J Med Date: 2010-05-16 Impact factor: 91.245