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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 17-22.e2 |
| Journal | Journal of Pediatrics |
| Volume | 209 |
| DOIs | |
| State | Published - Jun 2019 |
Keywords
- mortality
- oxygen saturation
- preterm
- retinopathy of prematurity
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
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Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm. / Foglia, Elizabeth E.; Carper, Benjamin; Gantz, Marie; DeMauro, Sara B.; Lakshminrusimha, Satyan; Walsh, Michele; Schmidt, Barbara; Caplan, Michael S.; Laptook, Abbott R.; Keszler, Martin; Hensman, Angelita M.; Knoll, Andrea M.; Little, Emilee; Vieira, Elisa; Basso, Kristin M.; Keller, Jennifer A.; Hibbs, Anna Maria; Fanaroff, Avroy A.; Newman, Nancy S.; Payne, Allison H.; Schibler, Kurt; Donovan, Edward F.; Grisby, Cathy; Bridges, Kate; Alexander, Barbara; Fischer, Estelle E.; Mincey, Holly L.; Hessling, Jody; Jackson, Lenora; Kirker, Kristin; Muthig, Greg; Tepe, Stacey; Cotten, C. Michael; Goldberg, Ronald N.; Auten, Kathy J.; Fisher, Kimberley A.; Finkle, Joanne; Carlton, David P.; Stoll, Barbara J.; Hale, Ellen C.; Loggins, Yvonne; Bottcher, Diane I.; Mackie, Colleen; Higgins, Rosemary D.; Archer, Stephanie Wilson; Poindexter, Brenda B.; Sokol, Gregory M.; Herron, Dianne E.; Miller, Lucy; Wilson, Leslie Dawn; Kennedy, Kathleen A.; Tyson, Jon E.; McDavid, Georgia E.; Arldt-McAlister, Julie; Burson, Katrina; Garcia, Carmen; Harris, Beverly Foley; Lis, Anna E.; Martin, Karen; Martin, Sara C.; Rodgers, Shawna; Simmons, Maegan C.; Pierce Tate, Patti L.; Das, Abhik; Wallace, Dennis; Poole, W. Kenneth; O'Donnell Auman, Jeanette; Crawford, Margaret M.; Petrie Huitema, Carolyn M.; Zaterka-Baxter, Kristin M.; Van Meurs, Krisa P.; Stevenson, David K.; Adams, Marian M.; Ball, M. Bethany; Ismail, Magdy; Palmquist, Andrew W.; Proud, Melinda S.; Carlo, Waldemar A.; Ambalavanan, Namasivayam; Collins, Monica V.; Cosby, Shirley S.; Bell, Edward F.; Colaizy, Tarah T.; Widness, John A.; Johnson, Karen J.; Walker, Jacky R.; Watterberg, Kristi L.; Ohls, Robin K.; Lacy, Conra Backstrom; Hartenberger, Carol H.; Beauman, Sandra Sundquist; Hanson, Mary Ruffaner; Wyckoff, Myra H.; Brion, Luc P.; Salhab, Walid A.; Rosenfeld, Charles R.; Vasil, Diana M.; Chen, Lijun; Guzman, Alicia; Hensley, Gaynelle; Lee, Lizette E.; Leps, Melissa H.; Miller, Nancy A.; Morgan, Janet S.; Pavageau, Lara; Shankaran, Seetha; Pappas, Athina; Bara, Rebecca; Natarajan, Girija.
In: Journal of Pediatrics, Vol. 209, 06.2019, p. 17-22.e2.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm
AU - Foglia, Elizabeth E.
AU - Carper, Benjamin
AU - Gantz, Marie
AU - DeMauro, Sara B.
AU - Lakshminrusimha, Satyan
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
AU - Kennedy, Kathleen A.
AU - Tyson, Jon E.
AU - McDavid, Georgia E.
AU - Arldt-McAlister, Julie
AU - Burson, Katrina
AU - Garcia, Carmen
AU - Harris, Beverly Foley
AU - Lis, Anna E.
AU - Martin, Karen
AU - Martin, Sara C.
AU - Rodgers, Shawna
AU - Simmons, Maegan C.
AU - Pierce Tate, Patti L.
AU - Das, Abhik
AU - Wallace, Dennis
AU - Poole, W. Kenneth
AU - O'Donnell Auman, Jeanette
AU - Crawford, Margaret M.
AU - Petrie Huitema, Carolyn M.
AU - Zaterka-Baxter, Kristin M.
AU - Van Meurs, Krisa P.
AU - Stevenson, David K.
AU - Adams, Marian M.
AU - Ball, M. Bethany
AU - Ismail, Magdy
AU - Palmquist, Andrew W.
AU - Proud, Melinda S.
AU - Carlo, Waldemar A.
AU - Ambalavanan, Namasivayam
AU - Collins, Monica V.
AU - Cosby, Shirley S.
AU - Bell, Edward F.
AU - Colaizy, Tarah T.
AU - Widness, John A.
AU - Johnson, Karen J.
AU - Walker, Jacky R.
AU - Watterberg, Kristi L.
AU - Ohls, Robin K.
AU - Lacy, Conra Backstrom
AU - Hartenberger, Carol H.
AU - Beauman, Sandra Sundquist
AU - Hanson, Mary Ruffaner
AU - Wyckoff, Myra H.
AU - Brion, Luc P.
AU - Salhab, Walid A.
AU - Rosenfeld, Charles R.
AU - Vasil, Diana M.
AU - Chen, Lijun
AU - Guzman, Alicia
AU - Hensley, Gaynelle
AU - Lee, Lizette E.
AU - Leps, Melissa H.
AU - Miller, Nancy A.
AU - Morgan, Janet S.
AU - Pavageau, Lara
AU - Shankaran, Seetha
AU - Pappas, Athina
AU - Bara, Rebecca
AU - Natarajan, Girija
N1 - Funding Information: 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. Funding Information: 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. 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. Data collected at participating sites of the NICHD NRN were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, Dr Abhik Das (DCC Principal Investigator), Dr Marie Gantz (DCC Statistician), and Mr Benjamin Carper (DCC Statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. 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. Funding Information: 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. 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. Data collected at participating sites of the NICHD NRN were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, Dr Abhik Das (DCC Principal Investigator), Dr Marie Gantz (DCC Statistician), and Mr Benjamin Carper (DCC Statistician) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis. We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. 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. Publisher Copyright: © 2019 Elsevier Inc.
PY - 2019/6
Y1 - 2019/6
N2 - 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.
AB - 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.
KW - mortality
KW - oxygen saturation
KW - preterm
KW - retinopathy of prematurity
UR - http://www.scopus.com/inward/record.url?scp=85063869380&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85063869380&partnerID=8YFLogxK
U2 - 10.1016/j.jpeds.2019.01.048
DO - 10.1016/j.jpeds.2019.01.048
M3 - Article
C2 - 30961990
AN - SCOPUS:85063869380
VL - 209
SP - 17-22.e2
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
ER -