Intermediate vs. high oxygen saturation targets in preterm infants: a national cohort study
Intermediate vs. high oxygen saturation targets in preterm infants: a national cohort study
Introduction: optimal oxygen saturation targets remain unknown for extremely preterm infants.
Methods: cohort analysis of eligible preterm infants born < 29 weeks gestation admitted between 2011 and 2018 to centers submitting data to the Canadian Neonatal Network (CNN) database. Site questionnaires to determine saturation targets, alarm settings, and date of change, allowed assignation of centers to intermediate (88 93%) or high (90 95%) saturation targets. A 6-month washout period was applied to sites which switched targets during the study period. Our primary outcome was survival free of major morbidity. Secondary outcomes were death, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity, and evidence of brain injury during admission. Generalized estimating equations were applied to compensate for demographic differences and site practices.
Results: there were 2,739 infants in the high (mean gestational age [GA] 26 ± 1.6 weeks) and 6,813 infants in the intermediate (mean GA 26.2 ± 1.6 weeks) saturation target group. Survival without morbidity was higher in the intermediate target group (adjusted odds ratio [aOR] 1.59; 95% CI: 1.04, 2.45). There was no difference in mortality between groups (aOR 0.81; 95% CI: 0.59, 1.11), in NEC, treated retinopathy, or brain injury. On subgroup analysis, restricting data to sites which switched targets during the study, intermediate saturation targets were associated with lower rates of BPD (aOR 0.45; 95% CI: 0.28, 0.72).
Conclusion: for neonates < 29 weeks gestation, intermediate saturation target was associated with higher odds of survival without major morbidity compared to higher oxygen saturation target.
Mortality, Necrotising enterocolitis (NEC), Neonatology, Outcome, Oxygen saturation, Preterm infant, bronchopulmonary dysplasia, neonatal, newborn, Bronchopulmonary dysplasia, Necrotizing enterocolitis
Taylor, Richard S.
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Singh, Balpreet
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Mukerji, Amit
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Dorling, Jon
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Alvaro, Ruben
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Lodha, Abhay
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El-Naggar, Walid
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Yoon, Eugene W.
763195e2-358f-488d-abb6-ca971f33a6c3
Shah, Prakesh S.
24a5b028-7ff0-4edd-b01a-1753262d68c9
Canadian Neonatal Network Investigators
Taylor, Richard S.
964549c0-7a3c-4b7e-b6a0-a08444cfb951
Singh, Balpreet
44820c9a-c0ec-4d16-a4b4-b4258065d3de
Mukerji, Amit
e01f6ffd-b78c-4f29-97b2-de38bec42a37
Dorling, Jon
e55dcb9a-a798-41a1-8753-9e9ff8aab630
Alvaro, Ruben
3bcc1aa1-99a0-493d-a4a7-e8608d212105
Lodha, Abhay
acd63c02-6d34-4c0f-a5fe-634707a06c65
El-Naggar, Walid
c77c2888-8794-4cf4-8546-babee5668f74
Yoon, Eugene W.
763195e2-358f-488d-abb6-ca971f33a6c3
Shah, Prakesh S.
24a5b028-7ff0-4edd-b01a-1753262d68c9
Taylor, Richard S., Singh, Balpreet, Mukerji, Amit, Dorling, Jon, Alvaro, Ruben, Lodha, Abhay, El-Naggar, Walid, Yoon, Eugene W. and Shah, Prakesh S.
,
Canadian Neonatal Network Investigators
(2024)
Intermediate vs. high oxygen saturation targets in preterm infants: a national cohort study.
Neonatology.
(doi:10.1159/000540278).
Abstract
Introduction: optimal oxygen saturation targets remain unknown for extremely preterm infants.
Methods: cohort analysis of eligible preterm infants born < 29 weeks gestation admitted between 2011 and 2018 to centers submitting data to the Canadian Neonatal Network (CNN) database. Site questionnaires to determine saturation targets, alarm settings, and date of change, allowed assignation of centers to intermediate (88 93%) or high (90 95%) saturation targets. A 6-month washout period was applied to sites which switched targets during the study period. Our primary outcome was survival free of major morbidity. Secondary outcomes were death, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity, and evidence of brain injury during admission. Generalized estimating equations were applied to compensate for demographic differences and site practices.
Results: there were 2,739 infants in the high (mean gestational age [GA] 26 ± 1.6 weeks) and 6,813 infants in the intermediate (mean GA 26.2 ± 1.6 weeks) saturation target group. Survival without morbidity was higher in the intermediate target group (adjusted odds ratio [aOR] 1.59; 95% CI: 1.04, 2.45). There was no difference in mortality between groups (aOR 0.81; 95% CI: 0.59, 1.11), in NEC, treated retinopathy, or brain injury. On subgroup analysis, restricting data to sites which switched targets during the study, intermediate saturation targets were associated with lower rates of BPD (aOR 0.45; 95% CI: 0.28, 0.72).
Conclusion: for neonates < 29 weeks gestation, intermediate saturation target was associated with higher odds of survival without major morbidity compared to higher oxygen saturation target.
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000540278
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Accepted/In Press date: 7 July 2024
e-pub ahead of print date: 5 August 2024
Keywords:
Mortality, Necrotising enterocolitis (NEC), Neonatology, Outcome, Oxygen saturation, Preterm infant, bronchopulmonary dysplasia, neonatal, newborn, Bronchopulmonary dysplasia, Necrotizing enterocolitis
Identifiers
Local EPrints ID: 493255
URI: http://eprints.soton.ac.uk/id/eprint/493255
ISSN: 1661-7800
PURE UUID: 895c3d8b-7f99-4e64-8ab8-232a46d63dd5
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Date deposited: 29 Aug 2024 16:31
Last modified: 30 Aug 2024 02:09
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Contributors
Author:
Richard S. Taylor
Author:
Balpreet Singh
Author:
Amit Mukerji
Author:
Jon Dorling
Author:
Ruben Alvaro
Author:
Abhay Lodha
Author:
Walid El-Naggar
Author:
Eugene W. Yoon
Author:
Prakesh S. Shah
Corporate Author: Canadian Neonatal Network Investigators
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