The Science Journal of the American Association for Respiratory Care

2008 OPEN FORUM Abstracts

MONITORING THE SPO2 VARABLITY OF NEONATES SUSEPTABLE TO RETINOPATHY OF PREMATURITY USING A MODIFIED PULSE OXIMETRY DATA COLLECTION SYSTEM

Brian K. Walsh1, Michael Davis1, David Kaufman1



Background: Known risk factors for retinopathy of prematurity (ROP) include prematurity and low birth weight. Much has been described in the literature regarding the role of supplemental oxygen in the development of ROP. In premature infants, the retina is incompletely vascularized. After birth, relative hyperoxia resulting from the administration of supplemental O2 may downregulate VEGF production; this can lead to the vaso-obliteration of existing vessels and arrest of retinal vascularization. It is possible that repeated cycles of hyperoxia and hypoxia favor the progression of ROP.

Methods:
In conjunction with Nellcor (Coviden, Pleasanton, CA) and Cardiopulmonary Corporation (Milford, CT) we developed a modified Oxinet III system that collected two-second sampling from 40 N600 pulse oximeters in our 42 bed NICU. This system then summarized the samples of each day into a table that included average SPO2, # of low and high SPO2 events, and the duration of events in minutes. Re-education of O2 and ventilation titration goals was completed and flyers were posted at every bedside and clinical office. Alarm limits were set at 83% and 93% for infants receiving O2 and 85% to 100% for infants receiving only room air.

Results:
208 patient were monitored from November 2006 to January 2008. Of those 208 patients, 89 were further analyzed for this study and weighed <1500g (range 370 - 1500g (average 940). The mean gestational age was 27 weeks (range 23 - 32 weeks); the median monitoring period length was 28 days (range 3-283). Table one is a summary of the 1st 10 days of life. There was a statically difference in all three groups.

Conclusions:
Our modified pulse oximetry system could predict who is at an increase risk for ROP and drive evidence based therapeutic interventions to reduce this morbidly. Furthermore, this system could also be used as an objective outcome measure to determine the efficacy of a specific treatment or protocol.