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Neonatology. 2018;114(4):323-331. doi: 10.1159/000490372. Epub 2018 Aug 8.

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

Author information

1
Australian and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealandbrian.darlow@otago.ac.nz.
2
Spanish Neonatal Network, Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain.
3
Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, Québec, Canada.
4
Finnish Medical Birth Register and Register of Congenital Malformations, Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu, Turku, Finland.
5
Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden.
6
Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel HaShomer, Israel.
7
Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
8
TIN Toscane Online, Division of Neonatology and Neonatal Intensive Care Unit, Department of Pediatrics, University Hospital of Pisa, Pisa, Italy.
9
Canadian Neonatal Network, Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada.
10
Illinois Neonatal Network, Saint-Louis, Illinois, USA.
11
Neonatal Research Network Japan, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
12
Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
13
Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
14
Spanish Neonatal Network, Department of Pediatrics, University of Salamanca, Salamanca, Spain.
15
Clinical Epidemiology and Biostatistics, McMaster University, Toronto, Ontario, Canada.
16
Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.
17
Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
18
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
19
Australian and New Zealand Neonatal Network, National Perinatal Epidemiology and Statistic Unit, Royal Hospital for Women, University of New South Wales, Randwick City, New South Wales, Australia.

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.

KEYWORDS:

Comparative analysis; Erythropoietin; Neonatal intensive care; Neonatal networks; Oxygen saturation targeting; Retinopathy of prematurity; Very preterm infants

PMID:
30089298
DOI:
10.1159/000490372

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