Oxygen delivery and monitoring in neonatal intensive care units in Mexico in 2011 and in 2023

Abstract Background Retinopathy of prematurity (ROP) is a leading cause of preventable blindness, notably in Latin America, with hyperoxia as a significant risk factor. This study evaluates the resource availability and utilization for administering and monitoring supplemental oxygen in Mexico. Methods In 2011, an observational study examined 32 government neonatal intensive care units (NICUs) across Mexico, recording data on occupancy, staffing levels, and oxygen delivery and monitoring equipment. Preterm infants receiving supplemental oxygen were observed. In 2023, 13 NICUs were revisited, and similar data were gathered. Staffing levels were benchmarked against recommendations from Argentina and the US. Results In 2011, only 38% of NICUs had adequate medical and staffing levels to meet recommended cot-to-staff ratios for all shifts. Ratios were poorer on weekends and at night. Only 25.5% of cots had blenders, and 80.1% had saturation monitors. Of 153 observed infants, 87% were monitored, with 53% exhibiting high oxygen saturation (≥96%) and 8% low saturation (≤89%). Alarm settings were inadequate, with 38% and 32% of upper and lower alarms switched off and 16% and 53% incorrectly set, respectively. In the 13 NICUs with data from 2011 and 2023, cot-to-staff ratios deteriorated over time, with no unit achieving recommended ratios for all shifts in 2023. Equipment provision remained consistent, with similar rates of baby monitoring (79% in 2011; 75% in 2023). High oxygen saturation rates decreased slightly from 54% in 2011 to 49% in 2023. More upper alarms were set (46% in 2011; 75% in 2023), but a higher proportion were incorrectly set (52% in 2011; 68% in 2023). Conclusions Between 2011 and 2023, cot-to-staff ratios worsened, and equipment for safe oxygen delivery and monitoring remained insufficient. Despite available monitoring equipment, oxygen saturations often exceeded recommended levels, and alarms were frequently not set or incorrectly configured. Urgent improvements are needed in healthcare workforce numbers and practices, along with ensuring adequate equipment for safe oxygen delivery.