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

Background: Exposure to excessive oxygen in preterm neonates is associated with morbiditiesincluding retinopathy of prematurity (ROP), chronic lung disease (CLD), andbrain injury.

We planned a quality improvement (QI) project to maximize thetime that neonates’ spend within the target oxygen saturation range (SpO2)of (88%-95%) among preterm infants on supplemental oxygen in the first week oflife. Methods: This was a prospective before-and-afterstudy done in a level III NICU of a tertiary care teaching hospital in India in3 phases (baseline -6 weeks, intervention-4 weeks and post intervention-6weeks) from January to May 2016. Inborn neonates 26-34 weeks of gestationreceiving supplemental oxygen in the first week of life were enrolled. The primaryobjective was to compare thepercentage of time per epoch (a consecutive time interval of 10 hours in a day)spent by preterm neonates within the target SpO2 range before andafter implementation of a comprehensive unit policy on oxygenadministration.  Pulse oximetry trendsfor 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-interventionphase, oxygen saturation histograms were constructed from the above data andused 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 postintervention phase met enrollment criteria and contributed to analysis ofoxygen saturation trends in 48 and 69 epochs respectively.  The neonates were comparable between the twophases but NICU had a higher bed occupancy and greater number of neonates onrespiratory support in the baseline phase. The percenttime 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 hyperoxicrange also decreased significantly from 27.3% (22.7) to 12.

5% (13.8) (p<0.001) inpost-intervention phase.  In a hierarchical model adjusted for NICU characteristics (nurse strength pershift, NICU bed occupancy and the number of neonates on respiratory support), thecompliance with oxygen saturation target and reduction of hyperoxia remainedsignificant.

Conclusion:Effective implementationof a comprehensive oxygen targeting policy through staff education along with frequentfeedback using oxygen histograms can improve compliance with oxygentargeting.   


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