Oxygen-saturation targets and outcomes in extremely preterm infants

Area of Science:

• Neonatal Medicine
• Pediatric Pulmonology
• Developmental Pediatrics

Background:

• Chronic hypoxemia in preterm infants on supplemental oxygen can impair growth and development.
• Previous studies suggested higher oxygen saturation ranges might be beneficial.

Purpose of the Study:

• To determine if a higher functional oxygen saturation range improves growth and neurodevelopment in preterm infants dependent on supplemental oxygen.
• To assess the impact of different oxygen saturation targets on health service utilization.

Main Methods:

• A multicenter, double-blind, randomized controlled trial involving 358 preterm infants (born <30 weeks gestation) dependent on oxygen at 32 weeks postmenstrual age.
• Infants were assigned to a standard (91-94%) or high (95-98%) oxygen saturation target range during supplemental oxygen therapy.
• Primary outcomes included growth and neurodevelopmental measures at 12 months corrected age.

Main Results:

• No significant differences in weight, length, head circumference, or major developmental abnormalities were observed between the standard and high-saturation groups at 12 months corrected age.
• The high-saturation group experienced longer durations of oxygen therapy and higher rates of dependence on supplemental oxygen at 36 weeks postmenstrual age.
• Pulmonary deaths were more frequent in the high-saturation group (6 vs. 1), though not statistically significant (P=0.12).

Conclusions:

• Targeting a higher oxygen saturation range (95-98%) in extremely preterm infants dependent on supplemental oxygen offers no significant advantage for growth or neurodevelopment.
• Higher oxygen saturation targets increase the duration of oxygen therapy and dependence, leading to a greater burden on health services.