Abstract
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 SpO2 policies. 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). 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). 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.
Highlights
Large-scale use of supplemental oxygen in neonatology started more than 75 years ago, to alleviate symptoms of neonatal respiratory distress, the leading cause of death among preterm infants at the time [1]
Rates of neonatal morbidities and neurodevelopmental impairment To allow comparison with outcomes from the recently published randomised controlled multicentre trials (RCTs) on SpO2 targeting in extremely low gestational age neonates (ELGANs), the following neonatal morbidities were analysed: rates of severe ROP [19], moderate/severe bronchopulmonary dysplasia (BPD) defined as a requirement for supplemental oxygen and/or mechanical respiratory support at 36 weeks postmenstrual age [20], severe periventricular/intraventricular haemorrhage (PIVH) [21], cystic periventricular leukomalacia [22], as well as necrotising enterocolitis (NEC) (Bell’s stage ≥2) [23]
Patient characteristics Overall, 241 ELGANs were included in our analysis; of these, 157 infants belonged to the high and 84 infants to the low SpO2 target cohorts
Summary
Large-scale use of supplemental oxygen in neonatology started more than 75 years ago, to alleviate symptoms of neonatal respiratory distress, the leading cause of death among preterm infants at the time [1]. By 1950, retrolental fibroplasia ( known as retinopathy of prematurity, ROP) was recognised as the principal cause of blindness in infants and oxygen toxicity was suspected to be an important factor in its pathogenesis [4]. Oxygen use in premature infants was generally restricted to an FiO2 of 40% [5]. A few years later, Avery and Oppenheimer concluded from an autopsy study of two cohorts with different use of oxygen (1944 to 1948: FiO2 60–80%, 1954–1958: FiO2 rarely exceeding 40%) that a restricted oxygen supplementation policy might be associated with increased mortality rates from hyaline membrane disease [6]. In the 1970s and 1980s, technologies became available to monitor transcutaneous partial pressure of oxygen and
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