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

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

doi:10.1016/j.jpeds.2019.01.048

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

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

Research output: Contribution to journal › Article › peer-review

14 Scopus citations

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	https://doi.org/10.1016/j.jpeds.2019.01.048
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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10.1016/j.jpeds.2019.01.048

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Foglia, E. E., Carper, B., Gantz, M., DeMauro, S. B., Lakshminrusimha, S., Walsh, M., Schmidt, B., Caplan, M. S., Laptook, A. R., Keszler, M., Hensman, A. M., Knoll, A. M., Little, E., Vieira, E., Basso, K. M., Keller, J. A., Hibbs, A. M., Fanaroff, A. A., Newman, N. S., ... Natarajan, G. (2019). Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm. Journal of Pediatrics, 209, 17-22.e2. https://doi.org/10.1016/j.jpeds.2019.01.048

Foglia, EE, Carper, B, Gantz, M, DeMauro, SB, Lakshminrusimha, S, Walsh, M, Schmidt, B, Caplan, MS, Laptook, AR, Keszler, M, Hensman, AM, Knoll, AM, Little, E, Vieira, E, Basso, KM, Keller, JA, Hibbs, AM, Fanaroff, AA, Newman, NS, Payne, AH, Schibler, K, Donovan, EF, Grisby, C, Bridges, K, Alexander, B, Fischer, EE, Mincey, HL, Hessling, J, Jackson, L, Kirker, K, Muthig, G, Tepe, S, Cotten, CM, Goldberg, RN, Auten, KJ, Fisher, KA, Finkle, J, Carlton, DP, Stoll, BJ, Hale, EC, Loggins, Y, Bottcher, DI, Mackie, C, Higgins, RD, Archer, SW, Poindexter, BB, Sokol, GM, Herron, DE, Miller, L, Wilson, LD, Kennedy, KA, Tyson, JE, McDavid, GE, Arldt-McAlister, J, Burson, K, Garcia, C, Harris, BF, Lis, AE, Martin, K, Martin, SC, Rodgers, S, Simmons, MC, Pierce Tate, PL, Das, A, Wallace, D, Poole, WK, O'Donnell Auman, J, Crawford, MM, Petrie Huitema, CM, Zaterka-Baxter, KM, Van Meurs, KP, Stevenson, DK, Adams, MM, Ball, MB, Ismail, M, Palmquist, AW, Proud, MS, Carlo, WA, Ambalavanan, N, Collins, MV, Cosby, SS, Bell, EF, Colaizy, TT, Widness, JA, Johnson, KJ, Walker, JR, Watterberg, KL, Ohls, RK, Lacy, CB, Hartenberger, CH, Beauman, SS, Hanson, MR, Wyckoff, MH , Brion, LP, Salhab, WA, Rosenfeld, CR, Vasil, DM, Chen, L, Guzman, A, Hensley, G, Lee, LE, Leps, MH, Miller, NA, Morgan, JS, Pavageau, L, Shankaran, S, Pappas, A, Bara, R & Natarajan, G 2019, 'Association between Policy Changes for Oxygen Saturation Alarm Settings and Neonatal Morbidity and Mortality in Infants Born Very Preterm', Journal of Pediatrics, vol. 209, pp. 17-22.e2. https://doi.org/10.1016/j.jpeds.2019.01.048

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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 (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.",

keywords = "mortality, oxygen saturation, preterm, retinopathy of prematurity",

author = "Foglia, {Elizabeth E.} and Benjamin Carper and Marie Gantz and DeMauro, {Sara B.} and Satyan 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} and Kennedy, {Kathleen A.} and Tyson, {Jon E.} and McDavid, {Georgia E.} and Julie Arldt-McAlister and Katrina Burson and Carmen Garcia and Harris, {Beverly Foley} and Lis, {Anna E.} and Karen Martin and Martin, {Sara C.} and Shawna Rodgers and Simmons, {Maegan C.} and {Pierce Tate}, {Patti L.} and Abhik Das and Dennis Wallace and Poole, {W. Kenneth} and {O'Donnell Auman}, Jeanette and Crawford, {Margaret M.} and {Petrie Huitema}, {Carolyn M.} and Zaterka-Baxter, {Kristin M.} and {Van Meurs}, {Krisa P.} and Stevenson, {David K.} and Adams, {Marian M.} and Ball, {M. Bethany} and Magdy Ismail and Palmquist, {Andrew W.} and Proud, {Melinda S.} and Carlo, {Waldemar A.} and Namasivayam Ambalavanan and Collins, {Monica V.} and Cosby, {Shirley S.} and Bell, {Edward F.} and Colaizy, {Tarah T.} and Widness, {John A.} and Johnson, {Karen J.} and Walker, {Jacky R.} and Watterberg, {Kristi L.} and Ohls, {Robin K.} and Lacy, {Conra Backstrom} and Hartenberger, {Carol H.} and Beauman, {Sandra Sundquist} and Hanson, {Mary Ruffaner} and Wyckoff, {Myra H.} and Brion, {Luc P.} and Salhab, {Walid A.} and Rosenfeld, {Charles R.} and Vasil, {Diana M.} and Lijun Chen and Alicia Guzman and Gaynelle Hensley and Lee, {Lizette E.} and Leps, {Melissa H.} and Miller, {Nancy A.} and Morgan, {Janet S.} and Lara Pavageau and Seetha Shankaran and Athina Pappas and Rebecca Bara and Girija Natarajan",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier Inc.",

year = "2019",

month = jun,

doi = "10.1016/j.jpeds.2019.01.048",

language = "English (US)",

volume = "209",

pages = "17--22.e2",

journal = "Journal of Pediatrics",

issn = "0022-3476",

publisher = "Mosby Inc.",

}

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

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

SN - 0022-3476

VL - 209

SP - 17-22.e2

JO - Journal of Pediatrics

JF - Journal of Pediatrics

ER -

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

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