Bedside Oxygen Histogram Monitoring in the NICU for Infants at Risk for Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is a vaso-proliferative disease process that is exclusive to premature infants and can be exacerbated by supplemental oxygenation administration. Infants that experience hypoxia and hyperoxia are at an increased risk of developing severe ROP. Bedside oxygen-histogram monitoring is a non-invasive technique to monitor the percentage of time that infants spend outside of their gestational-age based oxygen saturation range. This project aimed to increase nursing knowledge of the pathophysiology of ROP, how supplemental oxygen administration can affect the severity of ROP, implementation of bedside oxygen-histogram monitoring at a level three newborn intensive care unit, and to evaluate if there was a statistically significant change in median oxygen-histogram highs and lows pre and post implementation of oxygen-histogram monitoring. Methods: Methods included a pre and post education survey to determine if there was a change in nursing knowledge of ROP and oxygen-histogram monitoring. Educational material regarding the pathophysiology of ROP, the effects of supplemental oxygenation administration on the severity of ROP, and oxygen-histogram monitoring was disseminated via email as an electronic slide presentation to nursing staff. Bedside oxygen-histogram 12-hour highs and lows were obtained and documented on a bedside oxygen-histogram monitoring tool. Results: Retention of individuals that completed both pre- (n= 30) and post- (n=15) surveys following dissemination of educational material was 50%. The statistical significance of the difference between the pre- and post- education scores was determined using a Mann Whitney U test and found change in nursing knowledge of and confidence in obtaining and reporting oxygen-histogram values to be statistically significant (p =0.012, p = 0.019). A statistically significant change (p = 0.00012) in nursing education regarding risk factors for infants at risk for ROP, gestational age-appropriate oxygen saturation ranges, and interpretation of oxygen- histogram high and low percentages was determined with a Mann Whitney U test. The change in pre- and post-implementation of oxygen-histogram highs (n =15) was found to be statistically significant (p = 0.0027) via a Mann Whitney U test. Useability vs feasibility for bedside oxygen- histogram monitoring was found to be 98%. Conclusions: Bedside oxygen-histogram monitoring is a cost-effective non-invasive technique to monitor the percentage of time that an infant spends outside of their targeted oxygen- saturation ranges. More research will need to be conducted in order to determine if monitoring bedside oxygen-histograms has an effect on the severity of ROP.