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Low oxygen saturation target range is associated with increased incidence of intermittent hypoxemia
Juliann M Di Fiore1, Michele Walsh, Lisa Wrage
1Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH 44106, USA. jmd3@case.edu
Insights
A low oxygen saturation target in preterm infants increased the rate of intermittent hypoxemia events, particularly in the early and late neonatal periods. Event duration and severity were similar between groups, but timing requires further study.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Critical Care
Background:
- Intermittent hypoxemia is a concern in preterm infants.
- Oxygen saturation targets vary, impacting clinical outcomes.
- High-resolution pulse oximetry allows detailed monitoring.
Purpose of the Study:
- To compare the incidence of intermittent hypoxemia in preterm infants randomized to low versus high oxygen saturation targets.
- To investigate the relationship between oxygen saturation targets and the frequency, duration, and severity of hypoxemic events.
Main Methods:
- A randomized trial involving 115 preterm infants from the Surfactant, Positive Pressure, and Oxygenation Randomized Trial.
- Infants were assigned to low (85%-89%) or high (91%-95%) oxygen saturation target ranges.
- Oxygen saturation was monitored using high-resolution pulse oximetry until 36 weeks postmenstrual age or discharge criteria were met.
Main Results:
- The low oxygen saturation target group exhibited a higher rate of intermittent hypoxemia events (defined as SpO2 ≤80% for ≥10 seconds and ≤3 minutes).
- This increased rate was observed prior to 12 days and after 57 days of life.
- While event duration and severity increased with postnatal age, these were comparable between groups; however, the low target group had shorter intervals between events.
Conclusions:
- Targeting lower oxygen saturation levels in preterm infants is associated with a greater frequency of intermittent hypoxemia events.
- The timing of these events appears to be dependent on postnatal age.
- Further research is warranted to understand the impact of intermittent hypoxemia timing on neonatal morbidity.
Objective:
To test the hypothesis that preterm infants randomized to a low vs high O(2) saturation target range have a higher incidence of intermittent hypoxemia.
Study Design:
A subcohort of 115 preterm infants with high resolution pulse oximetry enrolled in the Surfactant, Positive Pressure, and Oxygenation Randomized Trial were randomized to low (85%-89%) or high (91%-95%) O(2) saturation target ranges. Oxygen saturation was monitored until 36 weeks postmenstrual age or until the infant was breathing room air without respiratory support for ≥72 hours.
Results:
The low target O(2) saturation group had a higher rate of intermittent hypoxemia (≤80% for ≥10 seconds and ≤3 minutes) prior to 12 days and beyond 57 days of life (P < .05). The duration shortened (P < .0001) and the severity increased (P < .0001) with increasing postnatal age with no differences between target saturation groups. The higher rate of intermittent hypoxemia events in the low target group was associated with a time interval between events of <1 minute.
Conclusion:
A low O(2) saturation target was associated with an increased rate of intermittent hypoxemia events that was dependent on postnatal age. The duration and severity of events was comparable between target groups. Further investigation is needed to assess the role of intermittent hypoxemia and their timing on neonatal morbidity.
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