Abstract Rationale Hypoxemia remains a major cause of morbidity and mortality among hospitalized neonates and children in low-resource settings. Oxygen is identified by the World Health Organization as an essential medicine, and appropriate oxygen therapy is vital for reducing preventable pediatric deaths. However, appropriate prescription and monitoring are crucial to ensuring therapeutic benefit and preventing harm. Limited data exist on oxygen prescribing practices in Nigerian tertiary hospitals, and no previous national audit has evaluated the completeness of oxygen therapy documentation in pediatric wards. This study sought to assess the extent of oxygen therapy use and evaluate the completeness of oxygen prescription and monitoring documentation across tertiary hospitals. Methods A cross-sectional clinical audit was conducted across 21 tertiary hospitals in the six geopolitical zones of Nigeria over one week in September 2024. All children aged 0-17 years newly commenced on oxygen within the review period were eligible. Trained research assistants screened daily admissions and reviewed case records using a structured questionnaire capturing demographics, diagnoses, indication for oxygen, delivery device, flow rate, pre-oxygen and post-oxygen hemoglobin oxygen saturation (SpO2) levels, and monitoring frequency. A six-point prescription completeness score was generated. Data were analyzed using SPSS version 25. Results Among 2,480 admissions, 490 (19.8%) children received oxygen therapy. The median (inter-quartile range) age was 25 (3-120) hours among neonates and 36 (11-96) months among older children, with male predominance (290, 59.2%). Common diagnoses were severe perinatal asphyxia (15.5%) in neonates, severe malaria (11.4%) and pneumonia (11.0%) in older children. The oxygen therapy documentation was inadequate. Pre-therapy SpO2 documentation was absent in 37.6% cases, the delivery device was unspecified in 54.1%, the target SpO2 was undocumented in 86.1% and 43.7% had no monitoring records. Two hundred and sixty-eight children (of 306 with pre-therapy SpO2 documented) had SpO2 levels less than 94% pre-therapy. The mean (±SD) completeness score was 3.38 (±0.85), with 270 (57.1%) prescribers scoring ≤3 while only 39 (8.0%) prescribers had a score ≥5. Conclusion Oxygen therapy is common in Nigerian tertiary pediatric wards; however, documentation of key clinical parameters required for safe and effective oxygen delivery is suboptimal. These findings underscore the urgent need for standardized oxygen prescription protocols, job aids, provider training, and routine clinical audits. Strengthening oxygen system quality and adherence to guidelines is critical to improving child survival and reducing preventable hypoxemia-related deaths in resource-limited settings. This abstract is funded by: None
Ibraheem et al. (Fri,) studied this question.