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Eyedealistic Vision: Optimizing Oxygenation to Reduce Severe Retinopathy of Prematurity in the Neonatal Intensive
Nikki Wilborn1, Robert Lynch, Patricia Allen
1Author Affiliations: Pediatrix Medical Group, Neonatology of Houston, Houston, Texas (Drs Wilborn and Lynch); and Texas Tech University Health Sciences Center, School of Nursing, Lubbock, Texas (Drs Allen and Toon).
Insights
Implementing standardized oxygen guidelines in neonatal intensive care units (NICUs) significantly reduced severe retinopathy of prematurity (ROP) rates. This quality improvement initiative highlights the importance of team education and adherence to protocols for preventing ROP in premature infants.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Quality Improvement Science
Background:
- Severe retinopathy of prematurity (ROP) rates are increasing globally, with suboptimal oxygenation practices identified as a key risk factor.
- Two neonatal intensive care units (NICUs) observed a rise in severe ROP cases, necessitating an investigation into preventative measures.
- ROP is a leading cause of childhood blindness, primarily affecting very low birthweight infants born before 30-32 weeks gestation.
Purpose of the Study:
- To decrease severe ROP rates by 20% in a level IV and a level III NICU.
- To investigate the impact of standardized oxygenation guidelines on severe ROP incidence.
Main Methods:
- A quality improvement project was conducted in two NICUs involving 255 at-risk infants.
- Interventions included staff education, implementation of new oxygen guidelines, standardized order sets, and alarm limits.
- Compliance with new guidelines and rates of severe ROP were monitored before and after implementation.
Main Results:
- Compliance with oxygen alarm limits reached the target of 90% at both NICU sites.
- Severe ROP rates decreased from 10% to 7% at the level IV NICU.
- Severe ROP rates dropped from 6% to 0% at the level III NICU over a 24-month period.
Conclusions:
- Standardized oxygenation guidelines, supported by comprehensive staff education, are effective in reducing severe ROP.
- Multidisciplinary team and family involvement are crucial for successful quality improvement initiatives in neonatal care.
- Further research is warranted to establish optimal standardized oxygen alarm limits for premature infants.
Background:
Rates of severe retinopathy of prematurity (ROP) continue to rise globally despite advances in healthcare. Differences in practices related to optimizing oxygenation is among key factors that increase the risk of severe ROP. A recent increase in severe ROP rates at 2 local neonatal intensive care units (NICUs) prompted further investigation into potential preventative practices.
Purpose:
The project team's goal was to reduce rates of severe ROP by 20% in the 2 participating units.
Methods:
A level IV and level III NICU were targeted, including 255 infants at risk for ROP. Interventions included staff education, implementation of new established oxygen guidelines, as well as use of order sets, and alarm limits. Compliance rates and severe ROP rates before and after new guideline implementation were assessed.
Results:
After implementing the new guidelines, average alarm limit compliance met project goals of 90% at both sites. Severe ROP rates declined from 10% to 7% in the level IV NICU site and from 6% to 0% in the level III NICU site during the 24-month study period from 2022 to 2023.
Implications For Practice And Research:
Education and increased understanding regarding risk factors for ROP patients are crucial to successfully implementing and sustaining standardized oxygenation guidelines. Including the entire healthcare team and patient families is key to successful QI initiatives and improving patient outcomes. Further research is needed for optimal standardized oxygen alarm limits for this patient population.
Video Abstract:
One of the leading causes of childhood blindness is retinopathy of prematurity (ROP). 1 ROP is a disease of the retina that affects premature infants, with the highest risk to very low birthweight (VLBW) infants born with a gestational age of less than 30 to 32 weeks or infants weighing less than 1500 grams. 2 There are 5 stages of ROP. Stages 1 and 2 are considered mild and resolve on their own. Stage 3 is considered moderate-severe and sometimes resolves independently, with many cases requiring treatment. Stages 4 and 5 ROP are deemed severe and require treatment.
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