77 - Home Pulse Oximetry in Infants with Bronchopulmonary Dysplasia (BPD): Impact of Alarm Parameters on Burden of Low SpO2 Alarms

Poster Number: 77
Publication Number: 77.437

Heidi M. Herrick, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Molly Passarella, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Chris Bonafide, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Sara B. DeMauro, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: One quarter of infants with BPD are prescribed home oxygen at discharge, yet compliance with home pulse oximetry is low. Despite parental reports of frequent alarms as a contributor to premature monitor discontinuation, the true burden of home oximeter alarms and the impact of alarm parameters on alarm incidence are unknown.

Objective: To determine the impact of low oxygen saturation (SpO2) limits and alarm delays on alarm incidence by simulating threshold adjustments using data from a trial of continuous home SpO2 monitoring in infants with BPD.

Design/Methods: The BPD Saturation Targeting trial is an ongoing randomized clinical trial (NCT03385330) in which preterm infants with moderate/severe BPD undergo continuous SpO2 monitoring (Masimo Rad-8) while asleep from 34-44 weeks postmenstrual age (PMA) to 6 months corrected age. In this secondary study we used home oximeter data from the 1st 4 weeks after hospital discharge in a portion of the trial cohort. We included patients with ≥8 hours (h) of usable data. All SpO2 readings of zero were considered artifact and excluded prior to analysis. We used the raw data to estimate the count of low SpO2 alarms that would occur with low SpO2 limits of 90%, 85%, and 80%, alarm delays of 0, 5, 10, and 15 seconds (s), and the default 8s averaging time. We tested for linear trends in the rate of alarms per 8h (to estimate the number of alarms in a typical night) using Cuzick’s test.

Results: Twenty infants with mean PMA of 47.4+/-5.2 weeks at discharge were included (Table 1). Figure 1 depicts the predicted number of alarms per 8h at 80%, 85%, and 90% SpO2 limits with 0, 5, 10, and 15s delays. Within each delay, lower SpO2 limits were associated with lower alarm rates (p < 0.001). Within a given SpO2 limit, longer alarm delays were associated with lower alarm rates (p < 0.001).Conclusion(s): We used patient-level data to demonstrate the burden of home oximeter low SpO2 alarms among infants with BPD. Further, we demonstrate the impact of alarm parameters on alarm incidence. With commonly used conservative parameters (SpO2 90%, 0s delay) families experience >23 alarms/8h as compared to < 1 alarm/8h with liberal parameters (SpO2 80%, 15s delay). Our data demonstrate that broadening SpO2 limits and/or adding alarm delays can significantly decrease alarm rates while preserving alarms for episodes of potentially critical hypoxemia. Providers might consider more liberal parameters at discharge to reduce alarm rates, allow parents and infants more opportunity for uninterrupted sleep, decrease caregiver alarm fatigue, and potentially improve compliance with home monitoring.

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