title: Improving manual oxygen titration in preterm infants by training and guideline implementation.
abstract: To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2within the target range (85-95%) was calculated (%SpO2-wtr). SpO2was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p < 0.005, with a decrease in the %SpO2> 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p < 0.05). There was no effect on the %SpO2< 85% (5.9 (2.8-7.9) % vs 6.2 (2.5-8) %; ns) and %SpO2< 80% (1.9 (1.0-3.0) % vs 1.7 (0.8-2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2< 80% reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2> 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004).
  
  
  CONCLUSIONS
  Training and guideline implementation in manual oxygen titration improved SpO2targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300, RC, Leiden, The Netherlands. h.a.van_zanten@lumc.nl.
authors.forename: Henriëtte A
authors.initials: HA
authors.lastname: van Zanten
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300, RC, Leiden, The Netherlands.|TiCC, Tilburg University, Tilburg, The Netherlands.
authors.forename: Steffen C
authors.initials: SC
authors.lastname: Pauws
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300, RC, Leiden, The Netherlands.
authors.forename: Evelien C
authors.initials: EC
authors.lastname: Beks
authors.affiliation: Neonatal Unit, Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Stenson
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300, RC, Leiden, The Netherlands.
authors.forename: Enrico
authors.initials: E
authors.lastname: Lopriore
authors.affiliation: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, J6-S, PO Box 9600, 2300, RC, Leiden, The Netherlands.
authors.forename: Arjan B
authors.initials: AB
authors.lastname: Te Pas
mesh_terms: D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000451:nursing*; D015931:Intensive Care, Neonatal / Q000379:methods*; D008297:Male; D017283:Neonatal Nursing / Q000193:education*; D010092:Oximetry; D010100:Oxygen / Q000009:adverse effects / Q000097:blood*; D010102:Oxygen Inhalation Therapy / Q000451:nursing*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D010100:Oxygen
keywords: Apnoea; Hyperoxaemia; Hypoxaemia; Preterm infant; Targeting oxygen