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

Elizabeth E Foglia ,Benjamin Carper,Barbara Schmidt,Sara C Martin ,Dennis Wallace ,Robin K Ohls ,Lijun Chen ,Lenora Jackson ,Cathy Grisby ,Carmen Garcia ,Kathleen A Kennedy ,David K Stevenson ,Kimberley Fisher ,Patti L Pierce Tate ,Julie Arldt-Mcalister ,Lara Pavageau ,Andrea M Knoll ,Kristin Kirker ,Ronald N Goldberg ,Holly L Mincey ,Angelita M Hensman ,Stacey Tepe ,Edward F Donovan ,Namasivayam Ambalavanan ,Andrew W Palmquist ,Kurt Schibler ,Janet S Morgan ,Beverly Foley Harris ,Karen Martin ,Sandra Sundquist Beauman ,Myra H Wyckoff ,Katrina Burson ,Marie G Gantz ,Anna Maria Hibbs ,Kristi L Watterberg ,Stephanie Wilson Archer ,Emilee Little ,Athina Pappas ,Rosemary D Higgins ,Waldemar A Carlo ,W Kenneth Poole ,Mohammed Ismail ,Diane I Bottcher ,Jacky R Walker ,Anna E Lis ,Shirley S Cosby ,Michele C Walsh ,Estelle E Fischer ,C Michael Cotten ,Melissa H Leps ,Kristin M Basso ,Allison H Payne ,Shawna Rodgers ,Alicia Guzman ,Marian M Adams ,Conra Backstrom Lacy ,Seetha Shankaran ,Edward F Bell ,Ellen C Hale ,Abhik Das ,Brenda B Poindexter ,Jody Hessling ,John A Widness ,Dianne E Herron ,Maegan C Simmons ,Tarah T Colaizy ,Kristin M Zaterka-Baxter ,Colleen Mackie ,Martin Keszler ,Nancy S Newman ,Rebecca Bara ,Yvonne Loggins ,Elisa Vieira ,Carolyn M Petrie Huitema ,Carol H Hartenberger ,Michelle Ball ,Barbara J Stoll ,Luc P Brion ,Nancy A Miller ,Leslie D Wilson ,Avroy A Fanaroff ,Michael S Caplan ,Monica V Collins ,Jonathan M Keller ,Sara B Demauro ,Lucy Miller ,Melinda S Proud ,Gregory M Sokol ,Kate Bridges ,Charles R Rosenfeld ,David P Carlton ,Satyanarayana Lakshminrusimha ,Kathy J Auten ,Jeanette O’donnell Auman ,Barbara D Alexander ,Joanne Finkle ,Georgia E Mcdavid ,Lizette E Lee ,Gaynelle Hensley ,Greg Muthig ,Krisa P Van Meurs ,Mary Ruffaner Hanson ,Walid A Salhab ,Jon E Tyson ,Karen Johnson ,Abbott R Laptook ,Diana M Vasil ,Margaret Crawford ,Girija Natarajan

doi:10.1016/j.jpeds.2019.01.048

Abstract

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. 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. 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. Changing SpO2 alarm policies was not associated with reduced mortality or increased severe ROP among infants born very preterm.

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