Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 145 No. 4546 (2015)

Gestational age-adapted oxygen saturation targeting and outcome of extremely low gestational age neonates (ELGANs)

  • Anja Hergenhan
  • Martina Steurer
  • Thomas M. Berger
DOI
https://doi.org/10.4414/smw.2015.14197
Cite this as:
Swiss Med Wkly. 2015;145:w14197
Published
01.11.2015

Summary

QUESTIONS UNDER STUDY: Optimal oxygen saturation (SpO2) targets for extremely low gestational age neonates (ELGANs, gestational age [GA] <28 weeks) are unknown. Conflicting results from five recently published multicentre trials, which randomised ELGANs to high (91 to 95%) or low (85 to 89%) SpO2 targets from birth up to a corrected GA of 36 weeks, prompted us to examine our experience with two different SpO2policies.

METHODS: We retrospectively compared outcomes of two cohorts of ELGANs which were exposed to two different SpO2 target policies adapted to the infants’ corrected GA. Between 1 January 2000 and 30 June 2007, SpO2 targets were 85 to 95% at <30 weeks and 88 to 97% at ≥30 weeks (high SpO2 target cohort, n = 157). Between 1 July 2007 and 31 December 2011, SpO2 targets were lowered to 80 to 90% at <30 weeks, 85 to 95% between 30 and 34 weeks and finally 88 to 97% at ≥34 weeks (low SpO2 target cohort, n = 84).

RESULTS: There were no statistically significant differences between the high and low SpO2 target cohorts in mortality rates (15.9 vs 17.9%, risk ratio [RR] 0.89; 95% confidence interval [CI] 0.50–1.60), incidences of severe retinopathy of prematurity (2.3 vs 0%, RR 3.68; 95% CI 0.19–70.3), or moderate/severe bronchopulmonary dysplasia (14.4 vs 21.1%, RR 0.68; 95% CI 0.37–1.26).

CONCLUSIONS:Adapting SpO2 targets to the advancing corrected GA seems safe and is associated with low incidences of short-term complications. Mortality rates did not vary with the two different SpO2 target policies utilised and were comparable to those reported from recently published randomised controlled SpO2 target trials.

References

  1. Philip AGS. The evolution of neonatology. Pediatr Res. 2005;58:799–815.
  2. Wilson J, Long S, Howard P. Respiration of premature infants: response to variations of oxygen and to increased carbon dioxide in inspired air. Am J Dis Child. 1942;63:1080–5.
  3. Anonymous. The early history of oxygen use for premature infants. Pediatrics. 1976;57:592–8.
  4. Campbell K. Intensive oxygen therapy as a possible cause of retrolental fibroplasia: a clinical approach. Med J Austral. 1951;2:48–50.
  5. Robertson AF. Reflections on errors in neonatology: I. The “Hands-Off” years, 1920 to 1950. J Perinatol. 2003;23:48–55.
  6. Avery M, Oppenheimer E. Recent increase in mortality from hyaline membrane disease. J Pediatr. 1960;57:553–9.
  7. Tin W, Milligan DW, Pennefather P, Hey E. Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed. 2001;84:F106–10.
  8. The STOP-ROP Multicenter Study Group. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics. 2000;105:295–310.
  9. Askie LM, Henderson-Smart DJ, Irwig L, Simpson JM. Oxygen-saturation targets and outcomes in extremely preterm infants. N Engl J Med. 2003;349:959–67.
  10. Darlow BA, Marschner SL, Donoghoe M, Battin MR, Broadbent RS, Elder MJ, et al. Randomized controlled trial of oxygen saturation targets in very preterm infants: two year outcomes. J Pediatr. 2014;165:30–5.
  11. Carlo WA, Finer NN, Walsh MC, Rich W, Gantz MG, Laptook AR, et al. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med. 2010;362:1959–69.
  12. Stenson BJ, Tarnow-Mordi WO, Darlow BA, Simes J, Juszczak E, Askie L, et al. Oxygen saturation and outcomes in preterm infants. N Engl J Med. 2013;368:2094–104.
  13. Vaucher YE, Peralta-Carcelen M, Finer NN, Carlo WA, Gantz MG, Walsh MC, et al. Neurodevelopmental outcomes in the early CPAP and pulse oximetry trial. N Engl J Med. 2012;367:2495–504.
  14. Schmidt B, Whyte RK, Asztalos EV, Moddemann D, Poets C, Rabi Y, et al. Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. JAMA. 2013;309:2111–20.
  15. Bancalari E, Claure N. Oxygenation targets and outcomes in premature infants. JAMA. 2013;309:2161–2.
  16. Polin RA, Bateman D. Oxygen-saturation targets in preterm infants. N Engl J Med. 2013;368:2141–2.
  17. Schmidt B, Roberts RS, Whyte RK, Asztalos EV, Poets C, Rabi Y, et al. Impact of study oximeter masking algorithm on titration of oxygen therapy in the canadian oxygen trial. J Pediatr. 2014;165:666–71.
  18. Samiee-Zafarghandy S, Saugstad OD, Fusch C. Do we have an answer when it comes to providing extremely preterm infants with optimal target oxygen saturation? Acta Paediatr. 2015;104:e130–3
  19. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–9.
  20. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723–9.
  21. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529–34.
  22. De Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992;49:1–6.
  23. Bell MJ, Ternberg JL, Feigin RD, Keating JP, Marshall R, Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978;187:1–7.
  24. Stenson B, Brocklehurst B, Cairns S, Deshpande S, Fleck BW, Halliday HL, et al. Abstracts of the Perinatal Medicine 2014 Congress, 9-11 June 2014, Harrogate, UK. Arch Dis Child Fetal Neonatal Ed. 2014;99(Suppl 1):A23.
  25. Saugstad OD, Aune D. Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology. 2014;105:55–63.
  26. Di Fiore JM, Walsh M, Wrage L, Rich W, Finer N, Carlo WA, et al. Low oxygen saturation target range is associated with increased incidence of intermittent hypoxemia. J Pediatr. 2012;161:1047–52.
  27. Lakshminrusimha S, Manja V, Mathew B, Suresh GK. Oxygen targeting in preterm infants: a physiological interpretation. J Perinatol. 2015;35:8–15.
  28. Hellstrom A, Smith LEH, Dammann O. Retinopathy of prematurity. Lancet. 2013;382:1445–57.
  29. Askie LM, Brocklehurst P, Darlow BA, Finer N, Schmidt B, Tarnow-Mordi W. NeOProM: Neonatal Oxygenation Prospective Meta-analysis Collaboration study protocol. BMC Pediatr. 2011;11:6.
  30. Claure N, Bancalari E, D’Ugard C, Nelin L, Stein M, Ramanathan R, et al. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics. 2011;127:e76–83.
  31. Chen ML, Guo L, Smith LEH, Dammann CEL, Dammann O. High or low oxygen saturation and severe retinopathy of prematurity: a meta-analysis. Pediatrics. 2010;125:e1483–92.
  32. Sola A, Golombek SG, Montes Bueno MT, Lemus-Varela L, Zuluaga C, Dominguez F, et al. Safe oxygen saturation targeting and monitoring in preterm infants: can we avoid hypoxia and hyperoxia? Acta Paediatr. 2014;103:1009–18.

Most read articles by the same author(s)