219 - Impact of racial bias on oxygen saturation targeting by bedside NICU staff.

Sunday, April 24, 2022

3:30 PM – 6:00 PM US MT

Poster Number: 219
Publication Number: 219.339

Bharath Srivatsa, Northside Hospital, Atlanta, GA, United States; Kenneth G. Kupke, Neonatology Associates of Atlanta, Atlanta, GA, United States

Presenting Author(s)

BS

Bharath Srivatsa, MD

Attending Neonatologist
Northside Hospital
Atlanta, Georgia, United States

Background: Racial differences in the incidence of retinopathy of prematurity (ROP) have been described in the literature. ROP can be prevented by close attention to oxygen saturation (SpO2) targeting by bedside staff. Measuring actual manual fraction of inspired oxygen (FiO2) titrations performed can serve as an indicator of beside SpO2 targeting efforts.

Objective: The objectives of this retrospective study are to study racial differences in ROP incidences, if any, in our NICU and to examine whether racial bias influenced oxygen titration performed by NICU staff to achieve optimal oxygen saturation targeting.

Design/Methods: The study subjects weighed < 1000 gms and were born between January 1, 2016 and December 31, 2020. A bedside oxygen analyzer capable of electronic data output recorded FiO2 data at 1-minute intervals (Figure 1). A subset of babies who had adequate simultaneous (FiO2) and SpO2 data available for the first 60 postnatal days was identified for studying oxygen titration performed by staff. This subset was divided into three groups- Black, Hispanic and White infants based on their maternal racial and ethnic characteristics. All instances of a change of greater than 1% FiO2 from the preceding FiO2 value were recorded to generate a titration score. The product of average titration score times 60 was defined as the Titration Index and it represented the number of hourly FiO2 titrations performed by the staff. Standard statistical methods were used to compare the Titration Indices between the three groups in univariate and multivariate models.

Results: There were 573 ELBW infants born during the study period. The incidence of severe ROP was significantly higher among Hispanic infants (24.6%) compared to Black (6.8%) and White (4.4%) infants respectively. 101 infants had adequate FiO2 and SpO2 data (Table 1). The incidence of severe ROP was similarly higher in this subset among Hispanic infants (46.7%) compared to Black (10.7%) and White (3.8%) respectively. There were no significant differences between the three groups in the Titration Indices (p=0.64) (Figure 2). There were no significant differences noted in Titration Indices after adjusting for gestational age, birth weight, 5-minute APGAR scores and ventilator days (p=0.728).Conclusion(s): The incidence of severe ROP was higher among Hispanic infants in our study compared to Black and White infants. We found no evidence of racial bias in oxygen titration performed by NICU staff to account for this finding.
Figure 1: Photograph showing Oxygen Analyzer (AX 300, Teledyne) and a network adapter connected to the inspiratory limb of a bubble CPAP circuit to generate downloadable, real-time, continuous FiO2 data for integration with SpO2 data.