Oxygen saturation histogram monitoring to reduce death or retinopathy of prematurity: a quality improvement initiative.

OBJECTIVES: Maintaining preterm infants within a goal oxygen saturation range challenges care providers. Through periodic assessment of saturation trends on infants' bedside histogram reports, our initiative aimed to (1) increase time spent at goal saturations and (2) reduce death or severe retinopathy of prematurity. STUDY DESIGN: The initiative integrated histogram monitoring into provider, respiratory, and nursing care. Achieved oxygen saturations, chart audits, and bedside histogram monitoring flowsheets provided process measures with the outcome measure of death or severe retinopathy of prematurity. RESULTS: In infants <29 weeks' gestation (n = 518), the rate of death or severe retinopathy of prematurity prior to hospital discharge decreased from 32.1% to 18.0%. Time at goal saturations (90-95%) increased from 48.7% to 57.6%. CONCLUSION: In infants born at <29 weeks' gestation, periodic, multidisciplinary oxygen saturation histogram monitoring improved time at goal saturations and was associated with a reduction in death or severe retinopathy of prematurity.

Early-Onset Neonatal Sepsis with Extended Spectrum Beta-Lactamase Producing Escherichia Coli in Infants Born to South and South East Asian Immigrants: A Case Series.

Extended-spectrum ß -lactamase (ESBL)-producing Enterobacteriaceae represent a major worldwide threat. We present three cases of early onset ESBL Escherichia coli sepsis in infants born to families from South and Southeast Asia to inform the practitioner community about this emerging threat. Infants with suspected sepsis, whose mother is from Asia or Southeast Asia, should be suspected of having an infection with an ESBL-producing organism, and practitioners should strongly consider adding a carbapenem to their usual initial antibiotic regimen.