544 - Utility of Overnight Pulse Oximetry in Clinical Decision Making Regarding Respiratory Support in Ex-Premature Babies With Bronchopulmonary Dysplasia

Publication Number: 3525.544

Michael Yong, Lee Kong Chian School of Medicine, Singapore, N/A, Singapore; Yee Yin Tan, Kk women’s and Children’s Hospital, Singapore, N/A, Singapore; Abdul Alim Abdul Haium, K K Women's and Children's Hospital, Singapore, N/A, Singapore; Biju Thomas, KK Women’s and Children’s Hospital, Singapore, N/A, Singapore; Odattil Geetha, SINGHEALTH, Singapore, N/A, Singapore

Background: Bronchopulmonary Dysplasia (BPD) is the most common complication of premature birth, with monitoring of oxygenation being crucial for management. While bedside continuous pulse oximetry remains the standard practice, utility of overnight pulse oximetry with short signal averaging time in guiding respiratory support decisions remains unclear.

Objective: To evaluate the clinical utility of overnight pulse oximetry in decision-making regarding respiratory support for ex-premature infants with BPD. Secondary aims included comparing outcomes between sequential studies, analyzing the impact of clinical covariates on oximetry parameters, and establishing baseline oximetry values across post-gestational ages in severe BPD.

Design/Methods: This retrospective cohort study analyzed 173 overnight pulse oximetry studies from 74 ex-premature infants with BPD between 2018-2024. Overnight pulse oximetry was performed using Masimo Radical-7 Pulse Oximeter with 2-second signal averaging time. Data collected included mean SpO2, nadir SpO2, desaturation index, and percentage time spent below 90% SpO2. Changes in respiratory support based on oximetry data were recorded. Sequential studies were compared and analyzed for differences in results and covariate effects. Baseline values were established across postmenstrual age groups.

Results: The majority of infants (87.8%) had severe BPD. From the first pulse oximetry studies, 39.2% of patients had changes in respiratory support (35.1% increased, 4.1% decreased). Analysis of all studies showed 28.3% resulted in respiratory support changes (19.7% increased, 8.7% decreased). Comparison between first and second studies showed significant improvements in nadir SpO2 (76% vs 85%, p=0.0004) and desaturation index (30.4 vs 16.6, p=0.0001). Clinical covariates showed no significant impact on oximetry parameters. Baseline data demonstrated progressive improvement in oxygenation stability with advancing postmenstrual age.

Conclusion(s): Overnight pulse oximetry using oximeters with short signal averaging time demonstrated utility in titration of respiratory support for ex-premature infants. There was significant improvement in overnight pulse oximetry results in the second study compared to the first thus ensuring the importance of repeating the pulse oximetry. Covariates did not significantly affect data. Baseline oximetry data improved with maturation. This study provides data on the utility of overnight pulse oximetry, filling a gap in existing literature. Further research is needed to evaluate long-term benefits and cost-effectiveness of this approach.

Table 1 title: Demographic and clinical details
Details were presented as mean unless otherwise mentioned. For respiratory support at time of discharge 3 patients were excluded as they were not yet discharged when these results were obtained

Clinical decision on respiratory support based on pulse oximetry data
The distribution of results from the total number of overnight pulse oximetries performed is illustrated in Table 2. Of the 74 patients, some had more than one pulse oximetry performed for titration of oxygen support, reaching a maximum of 9 studies for 1 patient. As such the total number of pulse oximetry studies done at 173 exceeds the number of patients.

Results from the first and second overnight pulse oximetry study
Comparison of the changes in respiratory support between first and second study to compare the difference in outcome. Of the original 74 patients, 48 of them underwent more than 1 overnight pulse oximetry. For these patients, a comparison of oxygen parameters during the study was made between the first and second studies.