Intermediate vs. High Oxygen Saturation Targets in Preterm Infants: A National Cohort Study.

Neonatology Pub Date : 2024-08-05 DOI:10.1159/000540278
Richard S Taylor, Balpreet Singh, Amit Mukerji, Jon Dorling, Ruben Alvaro, Abhay Lodha, Walid El-Naggar, Eugene W Yoon, Prakesh S Shah
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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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早产儿的中等氧饱和度目标与高氧饱和度目标:全国队列研究。
简介极早产儿的最佳血氧饱和度目标仍然未知:对2011年至2018年期间在向加拿大新生儿网络(CNN)数据库提交数据的中心收治的符合条件的妊娠29周早产儿进行队列分析。通过现场问卷调查确定饱和度目标、警报设置和更改日期,从而将各中心分配到中等(88-93%)或高(90-95%)饱和度目标。在研究期间转换目标的研究中心将有 6 个月的缓冲期。我们的主要结果是无重大疾病的存活率。次要结果包括死亡、坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、早产儿视网膜病变治疗以及入院时脑损伤证据。应用广义估计方程对人口统计学差异和医疗机构的做法进行了补偿:高饱和度(平均胎龄 26 ± 1.6 周)目标群体中有 2739 名婴儿,中等饱和度(平均胎龄 26.2 ± 1.6 周)目标群体中有 6813 名婴儿。中间目标组的无发病存活率更高(调整赔率 [aOR] 1.59;95% CI:1.04,2.45)。各组之间的死亡率(aOR 0.81;95% CI:0.59,1.11)、NEC、治疗后视网膜病变或脑损伤均无差异。在亚组分析中,将数据限制在研究期间转换目标的部位,中等饱和度目标与较低的BPD发生率相关(aOR 0.45;95% CI:0.28,0.72):对于妊娠 29 周的新生儿,与较高的血氧饱和度目标相比,中等饱和度目标与较高的无重大疾病存活率相关。
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