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

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Research output: Contribution to journalArticle

Abstract

Objective: To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO 2 ) 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 SpO 2 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 SpO 2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO 2 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 SpO 2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StatePublished - Jan 1 2019

Fingerprint

Infant Mortality
Oxygen
Morbidity
Retinopathy of Prematurity
Bronchopulmonary Dysplasia
Necrotizing Enterocolitis
Mortality
National Institute of Child Health and Human Development (U.S.)
Oximetry
Linear Models
Cohort Studies
Retrospective Studies

Keywords

  • mortality
  • oxygen saturation
  • preterm
  • retinopathy of prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm. / Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

In: Journal of Pediatrics, 01.01.2019.

Research output: Contribution to journalArticle

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. / Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm. In: Journal of Pediatrics. 2019.
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title = "Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm",
abstract = "Objective: To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO 2 ) 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 SpO 2 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 SpO 2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO 2 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 SpO 2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.",
keywords = "mortality, oxygen saturation, preterm, retinopathy of prematurity",
author = "{Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network} and Foglia, {Elizabeth E.} and Benjamin Carper and Marie Gantz and DeMauro, {Sara B.} and Satyanarayana Lakshminrusimha and Michele Walsh and Barbara Schmidt and Caplan, {Michael S.} and Laptook, {Abbott R.} and Martin Keszler and Hensman, {Angelita M.} and Knoll, {Andrea M.} and Emilee Little and Elisa Vieira and Basso, {Kristin M.} and Keller, {Jennifer A.} and Hibbs, {Anna Maria} and Fanaroff, {Avroy A.} and Newman, {Nancy S.} and Payne, {Allison H.} and Kurt Schibler and Donovan, {Edward F.} and Cathy Grisby and Kate Bridges and Barbara Alexander and Fischer, {Estelle E.} and Mincey, {Holly L.} and Jody Hessling and Lenora Jackson and Kristin Kirker and Greg Muthig and Stacey Tepe and Cotten, {C. Michael} and Goldberg, {Ronald N.} and Auten, {Kathy J.} and Fisher, {Kimberley A.} and Joanne Finkle and Carlton, {David P.} and Stoll, {Barbara J.} and Hale, {Ellen C.} and Yvonne Loggins and Bottcher, {Diane I.} and Colleen Mackie and Higgins, {Rosemary D.} and Archer, {Stephanie Wilson} and Poindexter, {Brenda B.} and Sokol, {Gregory M.} and Herron, {Dianne E.} and Lucy Miller and Wilson, {Leslie Dawn}",
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T1 - Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm

AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

AU - Foglia, Elizabeth E.

AU - Carper, Benjamin

AU - Gantz, Marie

AU - DeMauro, Sara B.

AU - Lakshminrusimha, Satyanarayana

AU - Walsh, Michele

AU - Schmidt, Barbara

AU - Caplan, Michael S.

AU - Laptook, Abbott R.

AU - Keszler, Martin

AU - Hensman, Angelita M.

AU - Knoll, Andrea M.

AU - Little, Emilee

AU - Vieira, Elisa

AU - Basso, Kristin M.

AU - Keller, Jennifer A.

AU - Hibbs, Anna Maria

AU - Fanaroff, Avroy A.

AU - Newman, Nancy S.

AU - Payne, Allison H.

AU - Schibler, Kurt

AU - Donovan, Edward F.

AU - Grisby, Cathy

AU - Bridges, Kate

AU - Alexander, Barbara

AU - Fischer, Estelle E.

AU - Mincey, Holly L.

AU - Hessling, Jody

AU - Jackson, Lenora

AU - Kirker, Kristin

AU - Muthig, Greg

AU - Tepe, Stacey

AU - Cotten, C. Michael

AU - Goldberg, Ronald N.

AU - Auten, Kathy J.

AU - Fisher, Kimberley A.

AU - Finkle, Joanne

AU - Carlton, David P.

AU - Stoll, Barbara J.

AU - Hale, Ellen C.

AU - Loggins, Yvonne

AU - Bottcher, Diane I.

AU - Mackie, Colleen

AU - Higgins, Rosemary D.

AU - Archer, Stephanie Wilson

AU - Poindexter, Brenda B.

AU - Sokol, Gregory M.

AU - Herron, Dianne E.

AU - Miller, Lucy

AU - Wilson, Leslie Dawn

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO 2 ) 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 SpO 2 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 SpO 2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO 2 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 SpO 2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.

AB - Objective: To determine the impact of policy changes for pulse oximetry oxygen saturation (SpO 2 ) 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 SpO 2 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 SpO 2 alarm policy change and 3685 infants in 9 hospitals without a policy change. The nature of most policy changes was to narrow the SpO 2 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 SpO 2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.

KW - mortality

KW - oxygen saturation

KW - preterm

KW - retinopathy of prematurity

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