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 journalArticlepeer-review

14 Scopus citations


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 languageEnglish (US)
Pages (from-to)17-22.e2
JournalJournal of Pediatrics
StatePublished - Jun 2019


  • mortality
  • oxygen saturation
  • preterm
  • retinopathy of prematurity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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