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      Using intermittent pulse oximetry to guide neonatal oxygen therapy in a low-resource context

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          Abstract

          Objective

          To evaluate the effectiveness of intermittent pulse oximetry in guiding oxygen therapy in neonates in a low-resource setting.

          Design and setting

          Prospective validation study at three hospitals in southwest Nigeria. We performed concealed continuous pulse oximetry on participants to evaluate intermittent SpO 2 monitoring.

          Patients

          We recruited all preterm or low birthweight neonates, and all term neonates who required oxygen therapy, who were admitted to the neonatal ward(s) of the study hospitals during the study period.

          Main outcome measures

          Proportion of time preterm/low birthweight neonates on oxygen spent within, above and below the target SpO 2 range of 90%–95%; and the proportion of time term neonates and neonates not on oxygen spent within and below the target range of 90%–100%.

          Results

          Preterm/low birthweight neonates receiving oxygen therapy (group A) spent 15.7% (95% CI 13.3 to 18.9) of time in the target SpO 2 range of 90%–95%. They spent 75.0% (63.6–81.1) of time above 95%, and 2.7% (1.7–5.6) of time below 85%. Term neonates and all neonates not receiving oxygen (group B) spent 97.3% (95% CI 96.4 to 98.6) of time within the target range of 90%–100%, and 0.9% (0.3–1.4) of time below 85%. Guidelines recommended SpO 2 monitoring 3 times per day for all patients, however neonates in groups A and B were monitored an average of 4.7 and 5.3 times per day, respectively.

          Conclusions

          To better maintain SpO 2 within the target range, preterm/low birthweight neonates on oxygen should have their SpO 2 monitored more frequently than the current 4.7 times per day. In all other neonates, however, monitoring SpO 2 5.3 times per day appears suitable.

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          Most cited references 29

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          Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control.

           Clare Gilbert (2008)
          Globally at least 50,000 children are blind from retinopathy of prematurity (ROP) which is now a significant cause of blindness in many middle income countries in Latin American and Eastern Europe. Retinopathy of prematurity is also being reported from the emerging economies of India and China. The characteristics of babies developing severe disease varies, with babies in middle and low income countries having a much wider range of birth weights and gestational ages than is currently the case in industrialized countries. Rates of disease requiring treatment also tend to be higher in middle and low income countries suggesting that babies are being exposed to risk factors which are, to a large extent, being controlled in industrialised countries. The reasons for this "third epidemic" of ROP are discussed as well as strategies for control, including the need for locally relevant, evidence based criteria which ensure that all babies at risk are examined.
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            Mechanisms and management of retinopathy of prematurity.

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              Retinopathy of prematurity in middle-income countries.

              In the 1940s and 1950s retinopathy of prematurity (ROP) was the single commonest cause of blindness in children in many industrialised countries; it now accounts for only 6-18% of blindness registrations. It is not known what proportion of blindness is due to ROP in countries that do not have blindness registers. Information on blindness in children in these countries can be obtained by examining children in schools for the blind. Between 1991 and 1996, 4121 children in 23 countries with a visual acuity in the better eye of less than 6/60 were examined with a standard method. The proportion of severe visual impairment or blindness due to ROP ranged from 0% in most African countries to 38.6% in Cuba. These data suggest that ROP is becoming a major cause of potentially preventable blindness among children in middle-income countries that have introduced neonatal intensive-care services for preterm and low-birthweight babies.
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                Author and article information

                Journal
                Arch Dis Child Fetal Neonatal Ed
                Arch. Dis. Child. Fetal Neonatal Ed
                fetalneonatal
                fnn
                Archives of Disease in Childhood. Fetal and Neonatal Edition
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                1359-2998
                1468-2052
                May 2020
                28 August 2019
                : 105
                : 3
                : 316-321
                Affiliations
                [1 ] departmentCentre for International Child Health, Department of Paediatrics , The University of Melbourne , Parkville, Victoria, Australia
                [2 ] departmentMedicine, Nursing & Health Sciences , Monash University , Clayton, Victoria, Australia
                [3 ] departmentDepartment of Paediatrics , University of Ibadan , Ibadan, Nigeria
                [4 ] University College Hospital Ibadan , Ibadan, Nigeria
                [5 ] departmentDepartment of Neonatology , Mother and Child Hospital , Akure, Nigeria
                [6 ] departmentTeaching Hospital Complex , University of Medical Sciences , Akure, Nigeria
                [7 ] departmentDepartment of Paediatrics , Sacred Heart Hospital , Abeokuta, Nigeria
                [8 ] departmentDepartment of Paediatrics , Monash University , Melbourne, Victoria, Australia
                [9 ] departmentMonash Newborn , Monash Children's Hospital , Melbourne, Victoria, Australia
                [10 ] departmentIntensive Care Unit and University of Melbourne Department of Paediatrics , Royal Children's Hospital , Parkville, Victoria, Australia
                [11 ] departmentDepartment of Child Health , School of Medicine and Health Sciences, University of Papua New Guinea , Port Moresby, Papua New Guinea
                [12 ] departmentCollege of Medicine , University of Ibadan , Ibadan, Nigeria
                [13 ] departmentDepartment of Paediatrics , University College Hospital Ibadan , Ibadan, Nigeria
                [14 ] Centre for International Child Health, University of Melbourne, Royal Children's Hospital , Parkville, Victoria, Australia
                Author notes
                [Correspondence to ] Dr Patrick James Berkeley Walker, Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC 3056, Australia; patrickjbwalker@ 123456gmail.com
                Article
                fetalneonatal-2019-317630
                10.1136/archdischild-2019-317630
                7363784
                31462405
                © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                Product
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;
                Award ID: OPP1123577
                Categories
                Original Research
                1506
                Custom metadata
                unlocked

                Neonatology

                low-resource, oxygen, oximetry, neonatology, spo2

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