Application of a Bundle in the Prevention of Peri-Intraventricular Hemorrhage in Preterm Newborns.

The purpose of this study was to evaluate the impact of implementing a care bundle for preventing peri-intraventricular hemorrhage (PIVH) in preterm newborns. A longitudinal, quantitative, quasi-experimental study was conducted with preterm newborns from a neonatal unit. The study was divided into 2 stages: the first consisted of a retrospective cohort of newborns (control group) not exposed to the bundle, and the second consisted of 5 practical steps of implementing a care bundle for preventing PIVH in eligible newborns. The results show that a significant reduction in PIVH occurred, from 34.8% before the intervention to 26.3% after application of the bundle. Also, after implementation of the bundle, there was a reduction in the severe forms of PIVH in the newborns who presented with hemorrhage compared with the control group. The study shows how the use of a low-cost and easy operationalization tool can contribute to the health of preterm newborns. It was found that the bundle is directly related to the decrease in the incidence of PIVH. The results may contribute to the improvement in care quality, thus promoting safe care for premature newborns.

Giving Voice to Parents in the Development of the Preemie Prep for Parents (P3) Mobile App.

BACKGROUND: Parents at risk for preterm birth frequently receive prematurity education when the mother is hospitalized for premature labor. Parental ability to learn and consider the information is limited because of the stress of the hospitalization. A promising approach is dissemination of information to at-risk parents before the birth hospitalization. PURPOSE: This article describes formative research used to develop smartphone-based prematurity education app for parents at-risk for preterm birth. METHODS: Stakeholders were parents with a prior preterm birth. Using stakeholder meeting transcripts, constant comparative analysis was used to reflect upon the parental voice. RESULTS: The parents named the app, Preemie Prep for Parents (P3). Parent perspectives revealed desire for information in the following 5 categories. (1) Power in knowledge and control: parents want autonomy when learning information that may influence medical decision-making. (2) Content and framing of information: they desire information from a trusted resource that helps promote prenatal health and provides neonatal intensive care information. (3) Displaying content: parents want personalization, push notifications, photographs displaying fetal development, and easy-to-understand statistics. (4) Providing information without causing harm: they desire non-value-laden information, and they do not support "gamifying" the app to enhance utilization. (5) Decision making: parents want information that would benefit their decision making without assuming that parents have a certain outlook on life or particular values. IMPLICATIONS FOR PRACTICE: These findings support the need for the P3 App to aid in decision making when parents experience preterm birth. IMPLICATIONS FOR RESEARCH: The findings highlight the need to study the effects of smartphone-based prematurity education on medical decision-making.

La enseñanza de enfermería: un camino de participación materna del cuidado del prematuro hospitalizado / Nursing education: a path of maternal participation in the care of the premature hospitalized / Educação em enfermagem: um caminho de participação materna no cuidado do prematuro hospitalizado

OBJETIVO: Describir el significado para la madre de participar en el cuidado al recién nacido prematuro en un grupo de madres que tenían sus hijos hospitalizados en una unidad neonatal de la ciudad de Bogotá, Colombia. METODOLOGÍA: Estudio cualitativo, con método de Etnoenfermería de pequeño alcance y aplicación de la teoría: Universalidad y diversidad del cuidado cultural de Madeleine Leininger. Los datos fueron obtenidos durante los meses de marzo a octubre del 2012, mediante la realización de 24 entrevistas a profundidad, notas de campo y observación participante a nueve informantes claves y cuatro informantes generales. RESULTADOS: Surgieron 28 códigos, 5 patrones y 2 temas centrales. Los dos temas centrales que definió el significado para la madre de participar en el cuidado al recién nacido prematuro hospitalizado fueron: Enseñanza de la enfermera: un camino de participación materna del cuidado del prematuro hospitalizado y el contexto de hospitalización del prematuro: un escenario influyente. CONCLUSIÓN: participar en el cuidado del prematuro hospitalizado para la madre significa contar con enseñanza de enfermería para cuidar al prematuro mediante explicación, observación, demostración y ejecución; en un contexto de predominio de lo ético sobre lo émico

OBJECTIVE: To describe the meaning for the mother to participate in the care of preterm birth, a group of mothers who had their children hospitalized in the neonatal unit in the city of Bogotá, Colombia. METHODOLOGY: Qualitative study, with a method of ethno-nursing of small scope and application of the theory: Universality and diversity of the cultural care of Madeleine Leininger. The data were obtained during the months of March to October 2012, through 24 in-depth interviews, field notes and participant observation to nine key informants and four general informantsRESULTS: 28 codes emerged, 5 patterns and 2 central themes. The two central themes that defined the meaning for the mother to participate in the care of the hospitalized premature newborn were: Nurse Education: A Way of maternal care participation and context hospitalized preterm premature hospitalization: an influential stage. CONCLUSIONS: participate in the care of hospitalized preterm birth for mother means having to care nursing education by the premature explanation, observation, demonstration and implementation, in a context of dominance of the ethical over the émic

OBJETIVO: Descrever o significado para a mãe de participar do cuidado ao recém-nascido prematuro em um grupo de mães que tiveram seus filhos internados em uma unidade neonatal na cidade de Bogotá, Colômbia. METODOLOGÍA: Estudo qualitativo, com um método de etno-enfermagem de pequeno alcance e aplicação da teoria: Universalidade e diversidade do cuidado cultural de Madeleine Leininger. Os dados foram obtidos nos meses de março a outubro de 2012, por meio de 24 entrevistas em profundidade, notas de campo e observação participante a nove informantes-chave e quatro informantes gerais. RESULTADOS: 28 códigos emergiram, 5 padrões e 2 temas centrais. Os dois temas centrais que definiram o significado para a mãe participar do cuidado do recém-nascido prematuro hospitalizado foram: Ensinar o enfermeiro: um caminho de participação materna no cuidado do prematuro hospitalizado e o contexto de hospitalização do prematuro: um cenário influente. CONCLUSÃO: participar do cuidado do prematuro hospitalizado para a mãe significa ter formação de enfermagem para cuidar do filho prematuro por meio de explicação, observação, demonstração e execução; em um contexto de predominância do ético sobre o emic

Evaluating the Use of a Decision Aid for Parents Facing Extremely Premature Delivery: A Randomized Trial.

OBJECTIVE: To assess decisional conflict and knowledge about prematurity among mothers facing extreme premature delivery when the counseling clinicians were randomized to counsel using a validated decision aid compared with usual counseling. STUDY DESIGN: In this randomized trial, clinicians at 5 level III neonatal intensive care units in the US were randomized to supplement counseling using the decision aid or to counsel mothers in their usual manner. We enrolled mothers with threatened premature delivery at 220/7 to 256/7 weeks of gestation within 7 days of their counseling. The primary outcome was the Decisional Conflict Scale (DCS) score. One hundred mothers per group were enrolled to detect a clinically relevant effect size of 0.4 in the Decisional Conflict Scale. Secondary outcomes included knowledge about prematurity; scores on the Preparedness for Decision Making scale; and acceptability. RESULTS: Ninety-two clinicians were randomized and 316 mothers were counseled. Of these, 201 (64%) mothers were enrolled. The median gestational age was 24.1 weeks (IQR 23.7-24.9). In both groups, DCS scores were low (16.3 ± 18.2 vs 16.8 ± 17, P = .97) and Preparedness for Decision Making scores were high (73.4 ± 28.3 vs 70.5 ± 31.1, P = .33). There was a significantly greater knowledge score in the decision aid group (66.2 ± 18.5 vs 57.2 ± 18.8, P = .005). Most clinicians and parents found the decision aid useful. CONCLUSIONS: For parents facing extremely premature delivery, use of a decision aid did not impact maternal decisional conflict, but it significantly improved knowledge of complex information. A structured decision aid may improve comprehension of complex information. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01713894.

NICU Nurses and Families Partnering to Provide Neuroprotective, Family-Centered, Developmental Care.

The aim of this project was to determine how implementing neuroprotective, family-centered, developmental care interventions would impact the satisfaction of nurses and families compared with traditional care in a NICU. Neuroprotective, family-centered, developmental care is grounded in the principle that optimal health outcomes are accomplished when patients' family members play an active role in contributing emotional, social, and developmental support for their babies. To accomplish this, nurses needed an understanding of the developmental problems associated with high-risk premature infants, fundamentals of neurosensory growth, and how the intrauterine environment protects the infant from the fluctuation of an unstable extrauterine environment. The model we chose to use was the Neonatal Integrative Developmental Care Model. Pre- and post-surveys showing an increase in knowledge and benefits of these interventions were collected from nurses. Pre- and post-Press Ganey reports showed families had a strong satisfaction with neuroprotective, family-centered, developmental care in our NICU.

Pacifier and swaddling effective in impeding premature infant's pain score and heart rate

Objective: To assess the effectiveness of pacifier and swaddling on premature infant's pain score, hearthrate, and oxygen saturation during an invasive procedure. Method: This randomized control trial involv 30 premature infants who were randomly assigned into control (n=15) and intervention (n=15) groups using parallel design. Infants in the intervention group received pacifier and swaddling when they were undergoing invasive procedures. The outcome indicators of the two-day intervention were pain score, hearth rate, and oxygen saturation. The Premature Infant Pain Profile (PIPP) was used in this study to measure infants' pain. Results: The paired t-test results showed that the pain score and heart rate were significantly increased following the procedure in the control group (p=0.003; p=0.013 < 0.05); meanwhile, there was no significant increase in the intervention group (p=0.256; p=0.783 > 0.005). There was no significant different in oxygen saturation in the control group (p=0.270) and in the intervention (p=0.370) group before and after the procedure. Conclusions: Providing pacifier and swaddling can impede the increase of premature infants' pain score and hearth rate during an invasive procedures, therefore it can be implemented as an alternative to pain management in premature infants

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Confort neonatal del recién nacido pre-término / Neonatal comfort of preterm infant

Justificación: la clarificación de conceptos es un elemento primordial en el desarrollo científico, estos son explicativos y permiten caracterizar los fenómenos de interés disciplinar. Propósito: clarificar el significado de confort neonatal, para desarrollar una definición operacional que permita comprender mejor las necesidades de los recién nacidos pre-término. Metodología: se realizó un análisis de concepto bajo la metodología de Walker y Avant. Resultado: una definición teórica actual y operacional para su uso en intervenciones de enfermería del cuidado neonatal. Conclusión: el introducir nuevos conceptos en la disciplina, permite al profesional de enfermería desarrollar habilidades para resolver problemas propios de la práctica diaria

Justification: clarification of concepts is a key factor in scientific development; they are explanatory and enable the characterization of disciplinary interest phenomena. Objective: to clarify the meaning of neonatal comfort, in order to develop an operational definition that enables a better understanding of the needs of preterm infants. Method: a concept analysis under Walker and Avant's methodology was performed. Results: a current theoretical and operational definition for its use in nursing interventions of neonatal care. Conclusions: introducing new concepts to the discipline enables the nursing professionals to develop skills to solve problems related to everyday practice

Cuidados de la piel del bebé prematuro / Skin care for preterm babies

Objetivo: actualizar los conocimientos de la anatomofisiología cutánea del RN prematuro y describir cuáles son los cuidados enfermeros más adecuados que se han de llevar a cabo para mantener íntegra esta primera línea de defensa. Método: búsqueda bibliográfica de los últimos 10 años (2007-2017) de artículos de revisión y originales en inglés, español, portugués y francés. Las bases de datos consultadas fueron: LILACS, Medline/PubMed, Bibliosaúde y Google Scholar. Se utilizaron términos MeSH y DeCS combinados con operadores booleanos. Resultados: la selección final fue de 59 artículos, 33 fueron revisiones bibliográficas y 22 artículos originales. Las principales lesiones son la dermatitis del pañal, las quemaduras térmicas y químicas, el arrancamiento de la piel, las lesiones por extravasación, los hematomas y las úlceras por presión (UPP). Cuanto menor es la edad gestacional, mayor es el riesgo de desarrollar una lesión en la piel, principalmente debido a la limitación de la movilidad espontánea y la exposición a la humedad. La clorhexidina produce quemaduras y eritemas, se recomiendan antisépticos con preparaciones no alcohólicas. Se han de evitar los baños diarios y el uso de jabones porque alteran el pH cutáneo y no permiten la formación del manto ácido. El uso de emolientes y el cuidado del cordón umbilical tienen controversias. Conclusiones: los principales temas estudiados fueron las prácticas de baño, los cuidados del cordón umbilical, la dermatitis del pañal, las UPP y el uso de adhesivos, emolientes y antisépticos. Los resultados obtenidos muestran controversia sobre los cuidados cutáneos a realizar. Son necesarios más estudios experimentales que permitan unificar los cuidados (AU)

Objective: to update the knowledge on cutaneous anatomical physiology in preterm newborns, and the most adequate nursing care that must be conducted in order to maintain the integrity of this first line of defence. Method: a bibliographical search over the past 10 years (2007-2017) including reviews and original articles in English, Spanish, Portuguese and French. The databases consulted were: LILACS, MEDLINE/PubMed, Bibliosaúde and Google Scholar. MeSH and DeCS terms were used, in combination with Boolean operators. Results: there was a final selection of 59 articles: 33 bibliographic reviews and 22 original articles. The main lesions were nappy rash, thermal and chemical burns, skin tears, extravasation injuries, bruises and pressure ulcers. At a lower gestational age, there is a higher risk of developing skin lesions, mainly due to the limitation in spontaneous mobility and exposure to humidity. Chlorhexidine causes burns and erythema; the use of non-alcoholic antiseptic agents is recommended. Daily baths and use of soap must be avoided, because they will alter the skin pH and prevent the formation of the acid coating. The use of emollient agents and the umbilical cord care are controversial. Conclusions: the main subjects studied were bath habits, umbilical cord care, nappy rash, pressure ulcers, and the use of adhesive, emollient and antiseptic agents. The outcomes reached were controversial in terms of the adequate skin care. Additional experimental studies are required, in order to standardize patient care (AU)

Dolor del recién nacido expuesto a procedimientos de enfermería en la unidad de neonatología de un hospital clínico chileno / Pain in the newborn in a neonatology unit of a clinical chilean hospital

El objetivo de este estudio fue valorar la intensidad del dolor en los recién nacidos frente a procedimientos de enfermería, que les fueron realizados con ocasión de los cuidados y tratamiento. Se sustentó desde la visión humanista del cuidado de Jean Watson. Metodología: Estudio descriptivo-correlacional, de corte transversal, cuya población estuvo constituida por recién nacidos hospitalizados en la Unidad de Neonatología del Hospital Clínico Herminda Martín de Chillán, en el período de junio a septiembre del año 2015. Para Valorar el dolor se aplicó la escala de valoración del dolor de Susan Givens Bell y un cuestionario semiestructurado de variables sociodemográficas. Resultados: La muestra estuvo conformada por 52 Recién Nacidos en un porcentaje igual de hombres y mujeres. El mayor número de procedimientos realizados fueron instalación de sonda orogástrica, punción venosa y arterial, siendo esta última la causante de dolor moderado en el R.N. El nivel de dolor presentado por la muestra, fue en un 42,3% dolor intenso, el 23,1% dolor moderado y en un 34,6 % no presentó dolor. El Instrumento presentó una confiabilidad con un alfa de Crombach de 0,802. Conclusiones: Los prematuros menores de 37 semanas sintieron mayor dolor que los RN de término.El peso de nacimiento se observó que a mayor peso mayor es el dolor. El APGAR de nacimiento en el estudio se observó que hay una relación directa, pero débil, que a mayor APGAR al nacer, mayor es dolor (AU)

This study was aimed to assess the intensity of pain in newborns against nursing treatments, which were performed during care and treatment. This was sustained from the humanist view of Jean Watson. Method: A cross-sectional descriptive-correlational study, whose population consisted of newborns hospitalized at the Neonatology Unit of the Herminda Martin Clinical Hospital of Chillán, Chile, in the period between June and September, 2015. In order to assess pain, Susan Givens Bell Assessment Scale was applied, as well as a semi-structured Questionnaire of sociodemographic variables. Results: The sample consisted of 52 newborns in an equal percentage of men and women. The greatest number of procedures was the nasogastric tube insetion, venipuncture and arterial puncture, being the latter the cause of moderate pain in newborns. The level of pain presented by the sample was 42.3% intense pain, 23.1% moderate pain and in 34.6% no pain was presented. The instrument presented reliability with a Cronbach’s alpha of 0.802. Conclusions: Premature infants under 37 weeks felt greater pain than full-term newborns. Regarding Barth weight, it was observed that the greater the weight, the grater the pain. Birth APGAR in the study indicated that there is a direct but weak relation and the higher APGAR at birth, the greater the pain (AU)

Evolución de indicadores de cuidados tras una intervención de alta precoz en recién nacidos prematuros / Evolution of care indicators after an early discharge intervention in preterm infants

Objetivo: Evaluar la evolución de resultados en salud en recién nacidos prematuros (RNP) incluidos en un programa de alta precoz. Método: Ensayo controlado no aleatorizado con grupo de intervención y grupo control. Se incluyen en el estudio los niños ingresados en la Unidad de Cuidados Neonatales del Hospital Universitario Virgen de las Nieves de Granada. El grupo intervención son niños ingresados en la Unidad Neonatal clínicamente estables, cuyo domicilio familiar esté situado en un radio de 20 kilómetros de distancia del hospital. Se adelanta dos semanas el alta hospitalaria y se realiza un seguimiento en domicilio por una enfermera experta en cuidados neonatales. El grupo control son niños que no se puedan incluir en seguimiento domiciliario por criterio de distancia al centro hospitalario o por falta de aceptación de la familia, los cuales recibirán la atención habitual hasta el momento del alta. Las variables de estudio son los indicadores de resultado de la Nursing Outcomes Classification. Resultados: Se han encontrado diferencias en evolución de la puntuación de las etiquetas de la Nursing Outcomes Classification en el grupo intervención respecto al grupo control. Conclusiones: El alta precoz de recién nacidos prematuros, seguidos en domicilio por una enfermera experta en cuidados neonatales, es un servicio sanitario que tiene resultados positivos sobre la preparación de los padres en los cuidados del hijo, sobre el conocimiento de recursos sanitarios, en la adaptación al cambio de vida y en el tiempo de lactancia materna. Se comporta como una actuación segura para los niños y beneficiosa para los padres (AU)

Objective: To evaluate the evolution of health outcomes in preterm infants included in an early discharge programme. Method: Controlled, non-randomised trial with an intervention group and a control group children admitted to the Neonatal Intensive Care Unit of the University Hospital Virgen de las Nieves of Granada were included in the study. The intervention group comprised preterm infants admitted to the neonatal unit clinically stable, whose family home was located within 20km. from the hospital. They were discharged two weeks before the established time and a skilled nurse in neonatal care monitored them at home. The control group comprised infants who could not be included in home monitoring due to the distance to the hospital criterion or because their families did not give their consent and who received the usual care until their discharge. The study variables were the outcome indicators of the Nursing Outcomes Classification. Results: Differences were found in the Nursing Outcomes Classification scores in the intervention group compared to the control group. Conclusions: The early discharge of preterm infants followed up at home by an expert nurse in neonatal care is a health service that achieves results in preparating parents for the care of their child, enabling them to learn about the health services, adapt to their new life, and establish breastfeeding times. It constitutes safe intervention for children and is beneficial to parents (AU)

Evaluación del desarrollo y cuidado individualizado del RN (NIDCAP) / Evaluation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP)

Objetivo: mostrar la evidencia científica sobre los resultados de la aplicación del Programa de Evaluación y Cuidado Individualizado del Desarrollo del Recién Nacido (NIDCAP) y sus potenciales beneficios clínicos en recién nacidos prematuros. Método: se llevó a cabo una revisión de la literatura, haciendo una búsqueda avanzada a través de PubMed, Cuiden, Scielo y Biblioteca Cochrane Plus, Google Académico y UpToDate. Dicha búsqueda se limitó a los idiomas inglés y español. El periodo de búsqueda fue el comprendido entre los años 2004 al 2016. Resultados: de los 281 documentos encontrados, fueron seleccionados 18. NIDCAP tiene el potencial de mejorar el desarrollo mental y psicomotor clínico. Los enfermeros, en comparación con el personal médico, tenían una actitud más positiva, mayor control conductual y una percepción de un mayor impacto positivo de NIDCAP en condiciones de UCIN. Las deficiencias en el diseño y métodos en los estudios revisados obstaculizan demandas de largo alcance sobre la eficacia del método. Los fundamentos científicos de los efectos del NIDCAP serían sustancialmente mejorados con estudios exhaustivos con seguimiento prolongado. Conclusiones: a pesar de los resultados esperanzadores en el desarrollo motor y cognitivo, y su valor de humanización, la evidencia científica sobre los efectos del NIDCAP es limitada al no demostrar que aporte mejorías clínicas significativas en el bebé prematuro. La evaluación de esta intervención integral, de alta complejidad, está cargada de una serie de problemas metodológicos. Las principales debilidades de los estudios están en los seguimientos a corto plazo y deficiencias metodológica, por lo que se necesitan estudios a largo plazo y con diseño centrado en objetivos concretos (AU)

Objective: to show the scientific evidence of the outcomes of the implementation of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) and its potential clinical benefits for pre-term newborns. Method: a literature review was conducted, through an advanced search in PubMed, Cuiden, Scielo and the Cochrane Plus Library, Academic Google and UpToDate. Said search was limited to English and Spanish. The search period included the years from 2004 to 2016. Results: eighteen (18) documents were selected of the 218 documents found. NIDCAP has the potential to improve mental and clinical psychomotor development. Compared with the medical staff, nurses had a more positive attitude, higher behavioural control, and a perception of a higher positive impact of NIDCAP in the NICU setting. The design and method deficiencies in the studies reviewed represent a barrier for long-term demands on the method efficacy. The scientific basis of NIDCAP effects would be significantly improved with comprehensive studies of prolonged follow-up. Conclusions: despite the hopeful outcomes on motor and cognitive development, and its humanization values, there is limited scientific evidence about NIDCAP effects, because it has not been demonstrated to offer significant clinical improvements in pre-term babies. The assessment of this comprehensive and high-complexity intervention is burdened by a series of methodological problems. The main weaknesses of the studies consist in their short-term follow-up and methodological problems. The main weaknesses of the studies consist in their short-term follow-up and methodological deficiencies; therefore, long-term studies are required, with a design focused on specific objectives (AU)

Professional Nurses' Perceptions of Skills Required for Performing Preterm Infants' Follow-up Assessments.

Improved perinatal and neonatal care enhances preterm infant survival rates, but the adverse outcomes remain high. Nurses play vitally important roles regarding the follow-up assessments, treatment, and care of preterm infants. This explorative, descriptive study aimed to describe nurses' perceptions of skills required to perform effective preterm infant assessments. Thirteen semistructured interviews were conducted. Identified themes included the role of the professional nurse, the importance of preterm infant assessments, lack of skills and knowledge to conduct quality assessments, formal and continuous development training needs, the absence of assessment tools and physical resources to perform standardized assessments of preterm infants, and the required support and referral systems.

Improving manual oxygen titration in preterm infants by training and guideline implementation.

To study oxygen saturation (SpO2) targeting before and after training and guideline implementation of manual oxygen titration, two cohorts of preterm infants <30 weeks of gestation needing respiratory support and oxygen therapy were compared. The percentage of the time spent with SpO2 within the target range (85-95%) was calculated (%SpO2-wtr). SpO2 was collected every minute when oxygen is >21%. ABCs where oxygen therapy was given were identified and analyzed. After training and guideline implementation the %SpO2-wtr increased (median interquartile range (IQR)) 48.0 (19.6-63.9) % vs 61.9 (48.5-72.3) %; p < 0.005, with a decrease in the %SpO2 > 95% (44.0 (27.8-66.2) % vs 30.8 (22.6-44.5) %; p < 0.05). There was no effect on the %SpO2 < 85% (5.9 (2.8-7.9) % vs 6.2 (2.5-8) %; ns) and %SpO2 < 80% (1.9 (1.0-3.0) % vs 1.7 (0.8-2.6) %; ns). In total, 186 ABCs with oxygen therapy before and 168 ABCs after training and guideline implementation occurred. The duration of SpO2 < 80% reduced (2 (1-2) vs 1 (1-2) minutes; p < 0.05), the occurrence of SpO2 > 95% did not decrease (73% vs 64%; ns) but lasted shorter (2 (0-7) vs 1 (1-3) minute; p < 0.004). CONCLUSION: Training and guideline implementation in manual oxygen titration improved SpO2 targeting in preterm infants with more time spent within the target range and less frequent hyperoxaemia. The durations of hypoxaemia and hyperoxaemia during ABCs were shorter. What is Known: • Oxygen saturation targeting in preterm infants can be challenging and the compliance is low when oxygen is titrated manually. • Hyperoxaemia often occurs after oxygen therapy for oxygen desaturation during apnoeas. What is New: • Training and implementing guidelines improved oxygen saturation targeting and reduced hyperoxaemia. • Training and implementing guidelines improved manual oxygen titration during ABC.