Differences in Caregiver Attitudes Towards Neonatal Oxygen Titration

Date of Award

Summer 2022

Document Type


Degree Name

Doctor of Healthcare Administration (DHA)

Committee Chair

Bora Pajo

Committee Member

Alyncia Bowen

Committee Member

Shawishi Haynes


Many infants admitted to neonatal intensive care units (NICUs) are at the risk of developing complications related to their prematurity, known as co-morbidities. Supplemental delivery of oxygen has been shown to help save the lives of these babies. However, too much oxygen can lead to co-morbidities such as Bronchopulmonary Dysplasia (BPD) and retinopathy of Prematurity (ROP). The primary assessment of how much oxygen a baby needs is performed by targeting a specific ordered saturation range via non-invasive pulse oximetry. Effective oxygen management is primarily the responsibility of the infant’s bedside caregiver. A host of literature, including Bapat et al. (2020) and McCauley et al.’s (2021), suggests that systematic weaknesses continue to prohibit the active titration of supplemental oxygen in targeting saturation ranges to maintain compliance with the ordered alarm settings. This study is aimed at identifying the current challenges for providing effective oxygen management for neonates through qualitative interviews of bedside care providers. More importantly, this study suggests that the compliance results found in one neonatal center’s quality improvement data may result from two overarching themes: “Barriers in the Workflow” and “Oxygen as a Drug.” This research suggests that these two themes and their supportive sub-themes influence the attitude of the bedside caregiver towards the task of oxygen titration. Furthermore, there may be a fundamental relationship between supportive respiratory modality and acuity perception. This relationship may influence the level of prioritization that the bedside caregiver places on engaging with the task of managing a premature infant’s supplemental oxygen delivery.