ABSTRACT
OBJECTIVE: Monitoring heart rate (HR) and oxygen saturation (SpO2) in infants is essential in the neonatal intensive care unit. Wireless pulse oximeter technology has been advancing but with limited accuracy data on preterm infants. This observational study compared HR and SpO2 of the wireless Owlet Smart Sock 3 (OSS3) to the wired Masimo SET (Masimo) pulse oximeter in preterm or <2.5 kg infants. STUDY DESIGN: Twenty-eight eligible infants were enrolled. They weighed between 1.7 and 2.5 kg and were without anomalies or medical instability. OSS3 and Masimo simultaneously monitored HR and SpO2 for 60 minutes. The data were aligned by time epoch and filtered for poor tracings. The agreement was compared using the Pearson's correlation coefficient, the Bland-Altman method, average root mean square (ARMS), and prevalence and bias adjusted kappa (PABAK) analyses. RESULTS: Two infants' data were excluded due to motion artifacts or device failures. The corrected gestational age and current weights were 35 ± 3 weeks and 2.0 ± 0.2 kg (mean ± standard deviation), respectively. Over 21 hours of data showed that HR was strongly correlated between the two devices (r = 0.98, p < 0.001), with a difference of -1.3 beats per minute (bpm) and the limit of agreement (LOA) -6.3 to 3.4 bpm based on the Bland-Altman method. SpO2 was positively correlated between the two devices (r = 0.71, p < 0.001) with a SpO2 bias of 0.3% (LOA: -4.6 to 4.5%). The estimated ARMS of OSS3 compared with Masimo was 2.3% for SpO2 in the 70 to 100% range. The precision decreased with lower SpO2. A strong agreement (PABAK = 0.94) was between the two devices on whether SpO2 was above or below 90%. CONCLUSION: OSS3 provided comparable HR and SpO2 accuracy to Masimo in preterm or <2.5 kg infants. Motion artifacts, lack of arterial blood gas comparisons, and lack of racial and ethnic diversity are the study limitations. More OSS3 data on the Lower HR and SpO2 ranges were needed before implementing inpatient use. KEY POINTS: · Pulse oximeters are vital for monitoring preterm infants' HR and SpO2 levels.. · Limited data exist on the accuracy of the wireless OSS3 on preterm infants.. · This observational study found that the OSS3 is comparable to the Masimo SET in measuring HR and SpO2 in preterm or <2.5 kg infants..
ABSTRACT
BACKGROUND: Diaper dermatitis (DD) causes discomfort and emotional distress and creates possible sources of infection among newborn intensive care unit infants. Diaper dermatitis remains prevalent despite studies documenting an understanding of prevention and treatment modalities. Standardizing perineal skin care guidelines could reduce DD. PURPOSE: Implement perineal skin care guidelines, while introducing novel diaper wipes, to decrease the incidence of DD by 20% within a 1-year period. METHODS: Our unit reviewed evidence-based literature to develop a standardized perineal care guideline for prevention and treatment, encompassing the use of novel, preservative-free diaper wipes with grapefruit seed extract. The outcome measures were the incidence and duration of DD. Process compliances were monitored. The balancing measure was the rate of fungal skin infection while using preservative-free wipes. FINDINGS: Between July 2017 and March 2019, 1070 infants were admitted for 1 or more days, with 11% of those being born at less than 30 weeks of gestational age. After guideline implementation in January 2018, the incidence of DD decreased by 16.7%. The incidence of severe cases dropped by 34.9%, with 3.5 days per 100 patient-days shortened duration. Process compliance was achieved. Neonates tolerated the novel wipes without increased fungal skin infection. IMPLICATIONS FOR PRACTICE: The Perineal Skin Care Guidelines could reduce the rate and duration of DD. Newborn intensive care unit infants tolerated the novel diaper wipes. IMPLICATIONS FOR RESEARCH: Additional research on wipes containing other types of extracts or ingredients.
