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

Elizabeth E Foglia; Benjamin Carper; Marie Gantz; Sara B DeMauro; Satyan Lakshminrusimha; Michele Walsh; Barbara Schmidt; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

doi:10.1016/j.jpeds.2019.01.048

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

Journal article

Open access

Peer reviewed

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

Elizabeth E Foglia, Benjamin Carper, Marie Gantz, Sara B DeMauro, Satyan Lakshminrusimha, Michele Walsh, Barbara Schmidt and Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

The Journal of pediatrics, Vol.209, pp.17-22.e2

06/2019

DOI: 10.1016/j.jpeds.2019.01.048

PMCID: PMC6535348

PMID: 30961990

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https://doi.org/10.1016/j.jpeds.2019.01.048View

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Abstract

To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO ) alarm limits on neonatal mortality and morbidity among infants born very preterm. 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 SpO 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. There were 3809 infants in 10 hospitals with an SpO alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO 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. Changing SpO alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.

Bronchopulmonary Dysplasia - diagnosis

Bronchopulmonary Dysplasia - epidemiology

Cohort Studies

Enterocolitis, Necrotizing - diagnosis

Enterocolitis, Necrotizing - epidemiology

Female

Health Policy

Humans

Infant

Infant Mortality - trends

Infant, Extremely Premature

Infant, Newborn

Intensive Care Units, Neonatal

Male

Morbidity - trends

Oximetry - methods

Oxygen Consumption - physiology

Policy Making

Retinopathy of Prematurity - diagnosis

Retinopathy of Prematurity - epidemiology

Retrospective Studies

Surveys and Questionnaires

Details

Title: Subtitle: Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm
Creators: Elizabeth E Foglia - University of Pennsylvania
Benjamin Carper - Research Triangle Park Foundation
Marie Gantz - Research Triangle Park Foundation
Sara B DeMauro - University of Pennsylvania
Satyan Lakshminrusimha - University of California, Davis
Michele Walsh - Case Western Reserve University
Barbara Schmidt - University of Pennsylvania
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Contributors: Tarah T Colaizy (Contributor) - University of Iowa, Neonatology
Edward F Bell (Contributor) - University of Iowa, Neonatology
Resource Type: Journal article
Publication Details: The Journal of pediatrics, Vol.209, pp.17-22.e2
DOI: 10.1016/j.jpeds.2019.01.048
PMID: 30961990
PMCID: PMC6535348
ISSN: 0022-3476
eISSN: 1097-6833
Grant note: UG1 HD027851 / NICHD NIH HHS UG1 HD053089 / NICHD NIH HHS UG1 HD040492 / NICHD NIH HHS UG1 HD027904 / NICHD NIH HHS U24 HD095254 / NICHD NIH HHS M01 RR008084 / NCRR NIH HHS UG1 HD027880 / NICHD NIH HHS U10 HD021373 / NICHD NIH HHS U10 HD040492 / NICHD NIH HHS U10 HD036790 / NICHD NIH HHS U10 HD053089 / NICHD NIH HHS U10 HD040689 / NICHD NIH HHS U10 HD027904 / NICHD NIH HHS U10 HD053109 / NICHD NIH HHS U10 HD027856 / NICHD NIH HHS K23 HD084727 / NICHD NIH HHS U10 HD027880 / NICHD NIH HHS U10 HD027853 / NICHD NIH HHS U10 HD021364 / NICHD NIH HHS U10 HD027851 / NICHD NIH HHS UG1 HD087229 / NICHD NIH HHS U10 HD034216 / NICHD NIH HHS UL1 TR001111 / NCATS NIH HHS UG1 HD040689 / NICHD NIH HHS UL1 TR001117 / NCATS NIH HHS U10 HD021385 / NICHD NIH HHS UG1 HD034216 / NICHD NIH HHS UG1 HD021364 / NICHD NIH HHS UG1 HD027853 / NICHD NIH HHS
Language: English
Date published: 06/2019
Academic Unit: Stead Family Department of Pediatrics; Neonatology
Record Identifier: 9984353927702771

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