Iycee Charles de Gaulle Summary Background: weeks, intervention-4 weeks and post intervention-6

Background: weeks, intervention-4 weeks and post intervention-6

Background: Exposure to excessive oxygen in preterm neonates is associated with morbidities
including retinopathy of prematurity (ROP), chronic lung disease (CLD), and
brain injury. We planned a quality improvement (QI) project to maximize the
time that neonates’ spend within the target oxygen saturation range (SpO2)
of (88%-95%) among preterm infants on supplemental oxygen in the first week of

Methods: This was a prospective before-and-after
study done in a level III NICU of a tertiary care teaching hospital in India in
3 phases (baseline -6 weeks, intervention-4 weeks and post intervention-6
weeks) from January to May 2016. Inborn neonates 26-34 weeks of gestation
receiving supplemental oxygen in the first week of life were enrolled. The primary
objective was to compare the
percentage of time per epoch (a consecutive time interval of 10 hours in a day)
spent by preterm neonates within the target SpO2 range before and
after implementation of a comprehensive unit policy on oxygen
administration.  Pulse oximetry trends
for an epoch were retrieved at a sampling frequency of 1 minute and the percent time spent within, above and below the target SpO2 range was derived. In the post-intervention
phase, oxygen saturation histograms were constructed from the above data and
used to provide feedback to the nurses twice daily.

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Results: A total of 9 neonates in the baseline phase and 11 in the post
intervention phase met enrollment criteria and contributed to analysis of
oxygen saturation trends in 48 and 69 epochs respectively.  The neonates were comparable between the two
phases but NICU had a higher bed occupancy and greater number of neonates on
respiratory support in the baseline phase. The percent
time spent within target saturation range increased (mean (SD)) from 65.9% (21.4) to 76.5% (12.6) (p=0.001).  The percentage of time spent in hyperoxic
range also decreased significantly from 27.3% (22.7) to 12.5% (13.8) (p<0.001) in post-intervention phase.  In a hierarchical model adjusted for NICU characteristics (nurse strength per shift, NICU bed occupancy and the number of neonates on respiratory support), the compliance with oxygen saturation target and reduction of hyperoxia remained significant. Conclusion: Effective implementation of a comprehensive oxygen targeting policy through staff education along with frequent feedback using oxygen histograms can improve compliance with oxygen targeting.