Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: The AVIOx study

James I. Hagadorn; Anne M. Furey; Tuyet Hang Nghiem; Christopher H. Schmid; Dale L. Phelps; De Ann M. Pillers; Cynthia H. Cole; Pamela K. Donohue; Jennifer A. Shepard; Wally Carlo; Monica Collins; Jennifer Rylander; Stephen Bean; Francis Bednarek; Tara Loiseau; Gopal Gupta; Cassandra Horihan; Erica Burnell; David Wheeler; Sue Escoe; Lu Ann Papile; Conra Backstrom Lacey; Brian Darlow; David G. Sweet; Henry L. Halliday; Ajay J. Talati; Sheldon B. Korones; Carl Bose; Courtney Winston; Anna Allen; Kathleen Meyer; Karen Christianson; Bhavesh L. Shah; Anne Hansen; Alan Fujii; James Hagadorn; Cynthia Cole; Anne Furey; Skyler Greene; Ami Vora; Jennifer Cho; Prashant Shrestha; Ekua Abban; Patricia Hibberd; Christopher Schmid; Sarah Brody-Kaplan; Christine Botelho; Marcia Landa; Marina Weisburd; Caitlin Hurley

doi:10.1542/peds.2005-0413

Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: The AVIOx study

James I. Hagadorn, Anne M. Furey, Tuyet Hang Nghiem, Christopher H. Schmid, Dale L. Phelps, De Ann M. Pillers, Cynthia H. Cole, Pamela K. Donohue, Jennifer A. Shepard, Wally Carlo, Monica Collins, Jennifer Rylander, Stephen Bean, Francis Bednarek, Tara Loiseau, Gopal Gupta, Cassandra Horihan, Erica Burnell, David Wheeler, Sue EscoeLu Ann Papile, Conra Backstrom Lacey, Brian Darlow, David G. Sweet, Henry L. Halliday, Ajay J. Talati, Sheldon B. Korones, Carl Bose, Courtney Winston, Anna Allen, Kathleen Meyer, Karen Christianson, Bhavesh L. Shah, Anne Hansen, Alan Fujii, James Hagadorn, Cynthia Cole, Anne Furey, Skyler Greene, Ami Vora, Jennifer Cho, Prashant Shrestha, Ekua Abban, Patricia Hibberd, Christopher Schmid, Sarah Brody-Kaplan, Christine Botelho, Marcia Landa, Marina Weisburd, Caitlin Hurley

School of Medicine

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

159 Scopus citations

Abstract

OBJECTIVE. The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at <28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range. METHODS. Infants who were <28 weeks' gestation and ≤96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling. RESULTS. Fourteen centers from 3 countries enrolled 84 infants with mean ± SD birth weight of 863 ± 208 g and gestational age of 26 ± 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance. CONCLUSIONS. Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.

Original language	English (US)
Pages (from-to)	1574-1582
Number of pages	9
Journal	Pediatrics
Volume	118
Issue number	4
DOIs	https://doi.org/10.1542/peds.2005-0413
State	Published - Oct 2006

Keywords

Neonatal
Oximetry
Oxygen saturation
Policies
Prematurity

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health

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10.1542/peds.2005-0413

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Hagadorn, J. I., Furey, A. M., Nghiem, T. H., Schmid, C. H., Phelps, D. L., Pillers, D. A. M., Cole, C. H., Donohue, P. K., Shepard, J. A., Carlo, W., Collins, M., Rylander, J., Bean, S., Bednarek, F., Loiseau, T., Gupta, G., Horihan, C., Burnell, E., Wheeler, D., ... Hurley, C. (2006). Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: The AVIOx study. Pediatrics, 118(4), 1574-1582. https://doi.org/10.1542/peds.2005-0413

Hagadorn, JI, Furey, AM, Nghiem, TH, Schmid, CH, Phelps, DL, Pillers, DAM, Cole, CH, Donohue, PK, Shepard, JA, Carlo, W, Collins, M, Rylander, J, Bean, S, Bednarek, F, Loiseau, T, Gupta, G, Horihan, C, Burnell, E, Wheeler, D, Escoe, S, Papile, LA, Lacey, CB, Darlow, B, Sweet, DG, Halliday, HL, Talati, AJ, Korones, SB, Bose, C, Winston, C, Allen, A, Meyer, K, Christianson, K, Shah, BL, Hansen, A, Fujii, A, Hagadorn, J, Cole, C, Furey, A, Greene, S, Vora, A, Cho, J, Shrestha, P, Abban, E, Hibberd, P, Schmid, C, Brody-Kaplan, S, Botelho, C, Landa, M, Weisburd, M & Hurley, C 2006, 'Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: The AVIOx study', Pediatrics, vol. 118, no. 4, pp. 1574-1582. https://doi.org/10.1542/peds.2005-0413

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title = "Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: The AVIOx study",

abstract = "OBJECTIVE. The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at <28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range. METHODS. Infants who were <28 weeks' gestation and ≤96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling. RESULTS. Fourteen centers from 3 countries enrolled 84 infants with mean ± SD birth weight of 863 ± 208 g and gestational age of 26 ± 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance. CONCLUSIONS. Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.",

keywords = "Neonatal, Oximetry, Oxygen saturation, Policies, Prematurity",

author = "Hagadorn, {James I.} and Furey, {Anne M.} and Nghiem, {Tuyet Hang} and Schmid, {Christopher H.} and Phelps, {Dale L.} and Pillers, {De Ann M.} and Cole, {Cynthia H.} and Donohue, {Pamela K.} and Shepard, {Jennifer A.} and Wally Carlo and Monica Collins and Jennifer Rylander and Stephen Bean and Francis Bednarek and Tara Loiseau and Gopal Gupta and Cassandra Horihan and Erica Burnell and David Wheeler and Sue Escoe and Papile, {Lu Ann} and Lacey, {Conra Backstrom} and Brian Darlow and Sweet, {David G.} and Halliday, {Henry L.} and Talati, {Ajay J.} and Korones, {Sheldon B.} and Carl Bose and Courtney Winston and Anna Allen and Kathleen Meyer and Karen Christianson and Shah, {Bhavesh L.} and Anne Hansen and Alan Fujii and James Hagadorn and Cynthia Cole and Anne Furey and Skyler Greene and Ami Vora and Jennifer Cho and Prashant Shrestha and Ekua Abban and Patricia Hibberd and Christopher Schmid and Sarah Brody-Kaplan and Christine Botelho and Marcia Landa and Marina Weisburd and Caitlin Hurley",

year = "2006",

month = oct,

doi = "10.1542/peds.2005-0413",

language = "English (US)",

volume = "118",

pages = "1574--1582",

journal = "Pediatrics",

issn = "0031-4005",

publisher = "American Academy of Pediatrics",

number = "4",

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TY - JOUR

T1 - Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation

T2 - The AVIOx study

AU - Hagadorn, James I.

AU - Furey, Anne M.

AU - Nghiem, Tuyet Hang

AU - Schmid, Christopher H.

AU - Phelps, Dale L.

AU - Pillers, De Ann M.

AU - Cole, Cynthia H.

AU - Donohue, Pamela K.

AU - Shepard, Jennifer A.

AU - Carlo, Wally

AU - Collins, Monica

AU - Rylander, Jennifer

AU - Bean, Stephen

AU - Bednarek, Francis

AU - Loiseau, Tara

AU - Gupta, Gopal

AU - Horihan, Cassandra

AU - Burnell, Erica

AU - Wheeler, David

AU - Escoe, Sue

AU - Papile, Lu Ann

AU - Lacey, Conra Backstrom

AU - Darlow, Brian

AU - Sweet, David G.

AU - Halliday, Henry L.

AU - Talati, Ajay J.

AU - Korones, Sheldon B.

AU - Bose, Carl

AU - Winston, Courtney

AU - Allen, Anna

AU - Meyer, Kathleen

AU - Christianson, Karen

AU - Shah, Bhavesh L.

AU - Hansen, Anne

AU - Fujii, Alan

AU - Hagadorn, James

AU - Cole, Cynthia

AU - Furey, Anne

AU - Greene, Skyler

AU - Vora, Ami

AU - Cho, Jennifer

AU - Shrestha, Prashant

AU - Abban, Ekua

AU - Hibberd, Patricia

AU - Schmid, Christopher

AU - Brody-Kaplan, Sarah

AU - Botelho, Christine

AU - Landa, Marcia

AU - Weisburd, Marina

AU - Hurley, Caitlin

PY - 2006/10

Y1 - 2006/10

N2 - OBJECTIVE. The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at <28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range. METHODS. Infants who were <28 weeks' gestation and ≤96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling. RESULTS. Fourteen centers from 3 countries enrolled 84 infants with mean ± SD birth weight of 863 ± 208 g and gestational age of 26 ± 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance. CONCLUSIONS. Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.

AB - OBJECTIVE. The objective of this study was to document pulse oximeter saturation levels achieved in the first 4 weeks of life in infants who were born at <28 weeks' gestation, compared with the levels that were targeted by local policy, and examine factors that are associated with compliance with the target range. METHODS. Infants who were <28 weeks' gestation and ≤96 hours of age were enrolled in a prospective, multicenter cohort study. Oximetry data were collected with masked signal-extraction oximeters for a 72-hour period in each of the first 4 weeks of life. Data were compared with the pulse oximeter saturation target range prescribed by local institutional policy. Factors that were associated with intended range compliance were identified with hierarchical modeling. RESULTS. Fourteen centers from 3 countries enrolled 84 infants with mean ± SD birth weight of 863 ± 208 g and gestational age of 26 ± 1.4 weeks. Oxygen saturation policy limits ranged between 83% and 92% for lower limits and 92% and 98% for upper limits. For infants who received respiratory support, median pulse oximeter saturation level achieved was 95%. Center-specific medial levels were within the intended range at 12 centers. Centers maintained infants within their intended range 16% to 64% of the time but were above range 20% to 73% of the time. In hierarchical modeling, wider target ranges, higher target range upper limits, presence of a policy of setting oximeter alarms close to the target range limits, and lower gestational age were associated with improved target range compliance. CONCLUSIONS. Success with maintaining the intended pulse oximeter saturation range varied substantially among centers, among patients within centers, and for individual patients over time. Most noncompliance was above the intended range. Methods for improving compliance and the effect of improved compliance on neonatal outcomes require additional research.

KW - Neonatal

KW - Oximetry

KW - Oxygen saturation

KW - Policies

KW - Prematurity

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ER -

Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks' gestation: The AVIOx study

Abstract

Keywords

ASJC Scopus subject areas

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