Title : Maintaining optimal oxygen saturation—the key to reduce both severe ROP & neurodisability
Abstract:
Introduction: History has shown that restricted use of oxygen leads to higher mortality and neuro disability, whereas liberal usage is linked to ROP. With the upgradation of Neonatal intensive care unit (NICU) of a tertiary health care unit, the number of premature infants surviving with severe ROP was increased. So, we tried to develop some strategies to maintain optimal O2 saturation in premature infants.
Methods: Structured quality improvement method i.e. plan-do -check-act cycle.
Results:
- A retrospective review of 80 premature infants (gestational age <32 weeks) with low birth weight (<2000 grams) admitted to NICU of a tertiary health care unit in 2023 was done. 16 patients developed ROP (7 stage 1, 5 stage 2, 3 stage 3 & 1 stage 4). Among them 5 required intravitreal injection & laser therapy, 2 of whom developed blindness despite treatment.
- Lack of appropriate recommendations and a lack of knowledge were found to be the main causes of increased ROP during staff evaluation.
- We developed a protocol and tracking tools: Spo2 target range chart (Stenson BJ) [1] was prepared & placed on each patient’s clipboard as visual reminder, Alarm limits [2] were adjusted and set, Spo2 trend & alarm limits were monitored & frequent audits were done.
- We educated both new and existing personnel about SpO2 targeting protocol & developed an algorithm for titrating fraction of inspired oxygen (FIO2).
- Following the intervention, there were fewer newborns with severe ROP who needed treatment & there was no discernible rise in the death rate.
Conclusion: Severe ROP can be prevented by implementing simple improvements in caregiving procedures. This study will throw some light on the importance of targeting Spo2 in the prevention of severe ROP.
Audience Take Away Notes:
- We ophthalmologist are always giving stress on ROP screening. But screening can only help in early detection of ROP.
- This study will provide a practical solution to maintain an optimal oxygen saturation in newborn infants & thereby help in prevention of ROP.
- This study will help the audience to learn some strategies to maintain optimal O2 saturation in premature infants. It will help to raise awareness about prevention of ROP, what is Spo2 target rage, importance of adherence to the appropriate oxygen target range, how to adjust the Fio2 & when & how to wean infants off oxygen support.
- These simple alteration in caregiving procedures will help to improve the present scenario of ROP.
