Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm - 23/05/19

Doi : 10.1016/j.jpeds.2019.01.048

Elizabeth E. Foglia, MD, MSCE ^1,^⁎ , Benjamin Carper, MS ², Marie Gantz, PhD ², Sara B. DeMauro, MD, MSCE ¹, Satyan Lakshminrusimha, MD ³, Michele Walsh, MD, MS ⁴, Barbara Schmidt, MD, MSc ¹
for the
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network^{^∗}
List of additional investigators is available at www.jpeds.com/ (Appendix).
Michael S. Caplan, MD, Abbott R. Laptook, MD, Martin Keszler, MD, Angelita M. Hensman, MS, RNC-NIC, Andrea M. Knoll, Emilee Little, RN, BSN, Elisa Vieira, RN, BSN, Kristin M. Basso, RN, MaT, Jennifer A. Keller, RN, BSN, Anna Maria Hibbs, MD, Avroy A. Fanaroff, MD, Nancy S. Newman, BA, RN, Allison H. Payne, MD, MS, Kurt Schibler, MD, Edward F. Donovan, MD, Cathy Grisby, BSN, CCRC, Kate Bridges, MD, Barbara Alexander, RN, Estelle E. Fischer, MHSA, MBA, Holly L. Mincey, RN, BSN, Jody Hessling, RN, Lenora Jackson, CRC, Kristin Kirker, CRC, Greg Muthig, BS, Stacey Tepe, BS, C. Michael Cotten, MD, MHS, Ronald N. Goldberg, MD, Kathy J. Auten, MSHS, Kimberley A. Fisher, PhD, FNP-BC, IBCLC, Joanne Finkle, RN, JD, David P. Carlton, MD, Barbara J. Stoll, MD, Ellen C. Hale, RN, BS, CCRC, Yvonne Loggins, RN, BSN, Diane I. Bottcher, RN, MSN, Colleen Mackie, BS, RT, Rosemary D. Higgins, MD, Stephanie Wilson Archer, MA, Brenda B. Poindexter, MD, MS, Gregory M. Sokol, MD, Dianne E. Herron, RN, CCRC, Lucy Miller, BSN, CCRC, Leslie Dawn Wilson, BSN, CCRC, Kathleen A. Kennedy, MD, MPH, Jon E. Tyson, MD, MPH, Georgia E. McDavid, RN, Julie Arldt-McAlister, RN, BSN, Katrina Burson, RN, BSN, Carmen Garcia, RN, CCRP, Beverly Foley Harris, RN, BSN, Anna E. Lis, RN, BSN, Karen Martin, RN, Sara C. Martin, RN, BSN, Shawna Rodgers, RN, Maegan C. Simmons, RN, Patti L. Pierce Tate, RCP, Abhik Das, PhD, Dennis Wallace, PhD, W. Kenneth Poole, PhD (deceased), Jeanette O'Donnell Auman, BS, Margaret M. Crawford, BS, CCRP, Carolyn M. Petrie Huitema, MS, CCRP, Kristin M. Zaterka-Baxter, RN, BSN, CCRP, Krisa P. Van Meurs, MD, David K. Stevenson, MD, Marian M. Adams, MD, M. Bethany Ball, BS, CCRC, Magdy Ismail, MD, MPH, Andrew W. Palmquist, RN, Melinda S. Proud, RCP, Waldemar A. Carlo, MD, Namasivayam Ambalavanan, MD, Monica V. Collins, RN, BSN MaEd, Shirley S. Cosby, RN, BSN, Edward F. Bell, MD, Tarah T. Colaizy, MD, MPH, John A. Widness, MD, Karen J. Johnson, RN, BSN, Jacky R. Walker, RN, Kristi L. Watterberg, MD, Robin K. Ohls, MD, Conra Backstrom Lacy, RN, Carol H. Hartenberger, MPH, RN, Sandra Sundquist Beauman, MSN, RNC-NIC, Mary Ruffaner Hanson, RN, BSN, Myra H. Wyckoff, MD, Luc P. Brion, MD, Walid A. Salhab, MD, Charles R. Rosenfeld, MD, Diana M. Vasil, MSN, BSN, RNC-NIC, Lijun Chen, PhD, RN, Alicia Guzman, Gaynelle Hensley, RN, Lizette E. Lee, RN, Melissa H. Leps, RN, Nancy A. Miller, RN, Janet S. Morgan, RN, Lara Pavageau, MD, Seetha Shankaran, MD, Athina Pappas, MD, Rebecca Bara, RN BSN, Girija Natarajan, MD

¹ Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
² RTI International, Research Triangle Park, NC
³ Department of Pediatrics, University of California Davis, Sacramento, CA
⁴ Case Western Reserve University, Cleveland, OH

^∗Reprint requests: Elizabeth E. Foglia, MD, MSCE, Division of Neonatology, Hospital of the University of Pennsylvania, 3400 Spruce St, 8th Floor, Ravdin Building, Philadelphia, PA 19104.Division of NeonatologyHospital of the University of Pennsylvania3400 Spruce St, 8th Floor, Ravdin BuildingPhiladelphiaPA19104

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.

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Keywords : preterm, oxygen saturation, mortality, retinopathy of prematurity

Abbreviations : BPD, FiO₂, GDB, NRN, ROP, SpO₂, SUPPORT

Plan

Methods

Policy Change Definition

Study Epoch Definition

Supported by the National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (K23HD084727 to E.F.). In addition, the National Institutes of Health, the NICHD, the National Center for Research Resources, and the National Center for Advancing Translational Sciences provided grant support for the Neonatal Research Network's Generic Database Study through cooperative agreements (U10 HD27904, U10 HD21364, M01 RR80, U10 HD27853, M01 RR8084, U10 HD40492, UL1 TR1117, M01 RR30, UL1 TR1111, U10 HD27851, M01 RR39, U10 HD27856, M01 RR750, U10 HD21373, U10 HD36790, U10 HD27880, M01 RR70, U10 HD34216, M01 RR32, U10 HD53109, M01 RR59, U10 HD53089, M01 RR997, U10 HD40689, M01 RR633, U10 HD21385). Although the NICHD staff did have input into the study design, conduct, analysis, and manuscript drafting, the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors declare no conflicts of interest.

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Vol 209

P. 17 - juin 2019 Retour au numéro

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Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm - 23/05/19

Abstract

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