Variations in Oxygen Saturation Targeting, and Retinopathy of Prematurity Screening and Treatment Criteria in Neonatal Intensive Care Units: An International Survey

Abstract

Background: Rates of retinopathy of prematurity (ROP) and ROP treatment vary between neonatal intensive care units (NICUs). Neonatal care practices, including oxygen saturation (SpO₂) targets and criteria for the screening and treatment of ROP, are potential contributing factors to the variations. Objectives: To survey variations in SpO₂ targets in 2015 (and whether there had been recent changes) and criteria for ROP screening and treatment across the networks of the International Network for Evaluating Outcomes in Neonates (iNeo). Methods: Online prepiloted questionnaires on treatment practices for preterm infants were sent to the directors of 390 NICUs in 10 collaborating iNeo networks. Nine questions were asked and the results were summarized and compared. Results: Overall, 329/390 (84%) NICUs responded, and a majority (60%) recently made changes in upper and lower SpO₂ target limits, with the median set higher than previously by 2–3% in 8 of 10 networks. After the changes, fewer NICUs (15 vs. 28%) set an upper SpO₂ target limit > 95% and fewer (3 vs. 5%) a lower limit < 85%. There were variations in ROP screening criteria, and only in the Swedish network did all NICUs follow a single guideline. The initial retinal examination was carried out by an ophthalmologist in all but 6 NICUs, and retinal photography was used in 20% but most commonly as an adjunct to indirect ophthalmoscopy. Conclusions: There is considerable variation in SpO₂ targets and ROP screening and treatment criteria, both within networks and between countries.

Trends in Outcomes for Neonates Born Very Preterm and Very Low Birth Weight in 11 High-Income Countries

“…11 Previously, we reported a significant variation in outcomes between the participating iNeo countries 16 as well as differences in some practices. [17][18][19][20][21] In this study, our aim was to analyze trends in the health outcomes of neonates born very preterm in 11 highincome countries. The impetus for this comparison came from iNeo objectives to understand variation, foster discussion and collaboration, and identify areas for improvement through the assessment of changes in neonatal outcomes within countries over time.…”

Management of oxygen saturation monitoring in preterm newborns in the NICU: the Italian picture

“…Multicenter, randomized and large-scale clinical trials have shown SpO 2 below 90%, during intensive care stay, Fig. 1 SpO 2 ranges used in participating NICUs are associated with a higher mortality, and saturation values higher than 95% are associated with increased morbidity [11,12,22]. The present study allowed to draw a representative picture of how the management of oxygen monitoring is performed in 93 neonatal intensive care units in Italy and which factors independently favored/refrained the use of the recommended targets.…”

Management of Oxygen Saturation Monitoring in Preterm Newborns in the NICU: The Italian Picture

“…To date there is no standardized SpO 2 interval, universally recognized as excellent by the scienti c community, to guarantee tissue oxygenation in the NICU setting. Multicenter, randomized and large-scale clinical trials have shown SpO 2 below 90%, during intensive care stay, are associated with a higher mortality, and saturation values higher than 95% are associated with increased morbidity [8,9,21]. Our study showed in 64.4% of the centers the lower limit of SpO 2 is set below 90%, highlighting a propensity to tolerate hypoxia; in contrast, in 24.4% of the centers the upper limit of SpO 2 is set above 95% re ecting a permissive attitude towards hyperoxia.…”