The Toxigen Initiative: Achieving Target Oxygen Saturations to Avoid Sequelae in Very Preterm Infants

Tuesday, July 12, 2011: 2:25 PM

Charlene M. Deuber, MSN
CHildrens Hospital of Philadelphhia Newborn Care, Pennsylvania Hospital, Philadelphia, PA
Mary Terhaar, RN
Health Systems and Outcomes, Johns Hopkins University School of Nursing, Baltimore, MD

Learning Objective 1: The participant will be able to identify three comorbidities resulting from pathophysiologic processes associated with hyperoxia among very preterm infants (VPI) receiving supplemental oxygen.

Learning Objective 2: The participant will be able to identify 4 nursing responsibilities and practices associated with reduction of exposure to hyperoxia among VPIs receiving supplemental oxygen.

Supplemental oxygen plays a key role in survival of very preterm infants but not without risk. A safe range for oxygen saturation (SpO2) has been suggested, yet these fragile infants continue to be exposed to hyperoxia inducing morbidity of significant consequence. The purpose of this presentation is to describe an interdisciplinary, evidence based quality improvement initiative aimed at reducing exposure to hyperoxia among VPI.


Two populations comprised project participants: VPI born at less than 28 weeks gestation and all professional staff in the NICU.


The Toxigen Initiative used educational and behavioral interventions to achieve 2 aims: increase staff knowledge and awareness of the evidence that connects hyperoxia to three significant sequelae; and reduce the percent of time that VPIs spend with oxygen saturations above target range (92%).

A pre-test post-test design was implemented and data were analyzed using paired t-tests for the knowledge assessment and independent t-tests for infant physiologic measures.


A systematic review of evidence on hyperoxia in VPIs produced reports on 1 randomized control trial, 7 quasi-experimental, and 2 non experimental studies. These formed the base for an hour long education program provided to all professional staff.   Utilizing an original, expert reviewed, knowledge assessment tool, caregiver understanding of hyperoxia was compared before and after an educational intervention (n=52). Subsequently behavioral interventions were used to reinforce retention of new knowledge and its application.

Two cohorts of VPIs comprised the sample: retrospective (previously admitted and discharged) and prospective (currently hospitalized). Oxygen saturation readings were archived in patient monitors, downloaded, and reviewed.  Percentage of time above target oxygen saturation range was calculated for each infant.   Aggregate scores were then created for each cohort and independent t-tests conducted to assess impact of the educational and behavioral interventions on exposure to hyperoxia.


Data collection will be complete Jan 31 and data analyzed in March.