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

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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.


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%.


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.

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We would like to acknowledge the care providers across all disciplines that enabled the success of this initiative.

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Correspondence to Samuel Gentle.

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Gentle, S., El-Ferzli, G., Winter, L. et al. Oxygen saturation histogram monitoring to reduce death or retinopathy of prematurity: a quality improvement initiative. J Perinatol (2019) doi:10.1038/s41372-019-0486-7

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