The impact of targeted oxygen reduction test in preterm infants on reducing the oxygen exposure

Area of Science:

• Neonatal care
• Respiratory support
• Quality improvement projects

Background:

• Caring for infants requiring respiratory support presents challenges in middle-income countries.
• A novel and practical approach involves a targeted oxygen reduction test (tORT) guided by daily oxygen histogram assessments.
• This method aims to optimize oxygen therapy and reduce patient length of stay.

Purpose of the Study:

• To evaluate the impact of tORT, guided by daily oxygen histogram assessments, as a quality improvement initiative.
• The primary goals were to decrease the duration of oxygen support and shorten hospital admission days for preterm infants.
• To assess the effectiveness of this protocol in a neonatal intensive care unit (NICU) setting.

Main Methods:

• A quality improvement project was conducted across two NICUs between 2017-2018 (Epoch II), following an observational period (Epoch I, 2016-2017).
• Infants in Epoch II underwent daily oxygen histogram assessments and protocolized trials of oxygen reduction (tORT).
• The primary outcome measured was the time to successful discontinuation of oxygen support, comparing outcomes between the two epochs.

Main Results:

• Fifty-nine preterm infants were included in the study.
• Infants in Epoch II (protocolized tORT) experienced significantly fewer days on oxygen and shorter hospital admissions compared to Epoch I.
• Oxygen histograms demonstrated significant improvement following the implementation of tORT.

Conclusions:

• The application of tORT, guided by oxygen histograms, shows a significant positive impact on reducing oxygen exposure.
• This approach may lead to a substantial decrease in hospitalization days for infants admitted to the NICU.
• tORT represents a practical and effective strategy for improving care for infants on respiratory support.