2007 OPEN FORUM Abstracts
MONITORING THE EFFECTIVENESS OF OXYGEN MANAGEMENT STRATEGIES USING A MODIFIED PULSE OXIMETRY DATA COLLECTION SYSTEM IN THE NEONATE
B. K. Walsh1, D. Kaufman1
Background: The major risk factors for retinopathy of prematurity (ROP) include prematurity and oxygen management. In premature infants, the retina is incompletely vascularized. Administration of supplemental O2 may lead to sustained hyperoxia, setting the stage for vaso-obliteration of existing vessels and arrest of the vascularization. Relative hyperoxia also downregulates VEGF and other growth factors contributing to arrested vascularization. It is possible that repeated cycles of hyperoxia and hypoxia favor the progression of ROP. With the improved survival of very low birth weight (VLBW) infants during the past decade, ROP continues to be a source of significant morbidity. Wide variability exists between NICUs in the incidence of severe ROP requiring laser ablation. These differences are attributed in a large part to the differences in clinical practice of oxygen titration to a specific oxygen saturation range and quantification of time spent in the desired saturation range.
Method: In conjunction with Nellcor (Pleasanton, CA) and Cardiopulmonary Corporation (Milford, CT) we developed a modified Oxinet III system that would collect two second sampling from OxiMax N-600 pulse oximeters in our 45 bed NICU. We started by re-educating staff of oxygen and ventilation titration goals and posted guidelines at every bedside and clinical office. The data collection system summarized each day in tabular form including average SPO2, number of low and high SPO2 events, duration of events in minutes, percentage of time infants spent outside of the intended saturation range. Alarm limits were set at 83% and 93% with infants in oxygen and 85% to 100% if the neonate was in room air.
Results: 35 infants with a median gestational age of 32 weeks (range 25-40 weeks) and a median birth weight of 1723g (range 370-3445g)were monitored for a median of 13 days (range 1-81). These infants spent a median of 2.13% (range 0.04%- 22.77)of time outside the intended saturation ranges, median of 1.14% (range 0%-20.14%) below the low saturation limit and a median of 0.82% (range 0%-9.12%) above the high saturation limit.
Conclusion: The modified Oxinet III system provides useful objective feedback information to measure the effectiveness of oxygen/ventilation management protocols and medications. As many infants spent more than 10% of their time outside the range, therapies to decrease periods of hypoxia and hyperoxia are critically needed and can be assessed using this system.