Abstract
Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) are diseases common among premature neonates, especially if supplemental oxygen is received. Because of the role supplemental oxygen plays in the two disease processes, guidelines for oxygen saturation parameters are important to guide the amount of supplemental oxygen that neonates receive. An understanding of the background, significance, current knowledge and identification of a framework is discussed. The purpose and aims for the quality improvement project were to audit the set saturation limits on the bedside monitors, examine percentages of ROP and BPD before and after the saturation protocol took place, and make recommendations for the current protocol based on the percentage changes.|Using Lewin's Model, oxygen saturation parameters were standardized at a Level III Neonatal Intensive Care Unit (NICU) in Lincoln, Nebraska in January 2018. The neonatology team reviewed current literature to determine the new protocol. The new protocol requires infants less than 35 weeks corrected gestation to be ordered 91-95% on the oxygen saturation monitor. For infants greater than 35 weeks corrected gestational age, the saturation limits are set at 93-98%. Percentage changes were evaluated before and after implementation of the new protocol using data from the Vermont Oxford Network.|Results concluded there was an increase in admissions over the last 5 years. Very low birthweight (VLBW) infant admissions remained consistent, although the overall number of VLBW infants increased in 2018 along with the increase in total admissions. These infants are high risk for developing ROP and BPD. ROP rates were the second highest in the past five years at 44.7% for those who qualified for eye exams. BPD rates were 30.2% in 2018; this was the highest rate in the past five years. There was a 98% compliance rate with bedside audits of the ordered saturation parameters.|While the results showed increased numbers of ROP and BPD rates, Vermont Oxford Network does not separate out the infants who are less than 1000 grams at birth from the VLBW group of infants less than 1500 grams. The NICU may have had an increase in Extremely Low Birth Weight (ELBW) infants less than 1000 grams, who are at a high risk for developing ROP and BPD. Data was not collected on subgroups of infants, based on gestational age. Since these infants are at different pulmonary and retinal stages of development; this data would be beneficial.|The consensus of the neonatology team was to keep the current oxygen saturation protocol and continue to monitor the rates of ROP and BPD quarterly. If an increase is seen, the oxygen saturation protocol will be changed. Audits of the oxygen saturation monitors will be continued to ensure the protocol is being followed by the bedside staff.