The toxigen initiative: Achieving target oxygen saturations to avoid sequelae in very preterm infants (VPIs)

Abstract

<p>Supplemental oxygen plays a key role in survival of Very Preterm Infants but not without risk. A safe range for oxygen saturation (SPO2) has been suggested, yet infants continue to be exposed to hyperoxia which induces significant sequelae.</p> <p><strong>Background: </strong>Longitudinal studies highlight the association of SpO2 readings above 92% ("hyperoxia") and the development of retinopathy of prematurity, chronic lung disease, and brain injury in VPIs.</p> <p><strong>Methods:</strong> Retrospective and prospective cohorts of VPIs were included. Oxygen saturation readings were archived in patient monitors, downloaded, and reviewed. Percentage of time above target oxygen saturation range was calculated for each infant in Cohort 1 (pre-intervention) and Cohort 2 (post intervention). Translation: An education program based on the evidence was provided for physicians assistants, nurses, nurse practitioners, respiratory therapists, residents and physicians. Utilizing an original, expert reviewed, knowledge assessment tool, caregiver understanding of hyperoxia was compared before and after the educational intervention. Behavioral interventions reinforced new knowledge and its application.</p> <p><strong>Results: </strong>Kowledge -Baseline knowledge and knowledge retained 3 months after intervention were measured. Treatment effect will be evaluated using t-tests. Hyperoxia - was reported as the time infants spent with oxygen saturations above 92% per day for five consecutive days. Independent t-tests will be conducted to assess impact of the interventions on exposure to hyperoxia.</p> <p><strong>Outcome: </strong>Staff knowledge data and infant hyperoxia data will be available in March of 2011. Outcome of this translation project will be available for presentation in October.</p> <p><strong>Implication:</strong> Mitigating risks associated with treatment is the responsibility of every professional engaged in care of preterm infants. Evidence directs clinicians to reduce the severity and duration of hyperoxia which may find its place on the list of never events for which care will no longer be reimbursed; the ethical and financial ramifications of hyperoxia can be expected to draw further attention and concern.</p>