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Oxygen saturation and outcomes in preterm infants
The New England Journal of Medicine
|May 7, 2013
Summary
Targeting lower oxygen saturation (85-89%) in extremely preterm infants increased mortality risk. While it reduced retinopathy of prematurity, it also raised necrotizing enterocolitis rates, indicating a complex risk-benefit balance.
Area of Science:
- Neonatalogy
- Clinical Trials
- Pediatric Critical Care
Background:
- The optimal oxygen saturation range for preterm infants remains undefined.
- Previous research suggested lower oxygen saturation targets may decrease retinopathy of prematurity rates.
Purpose of the Study:
- To evaluate the impact of targeting lower oxygen saturation (85-89%) versus higher saturation (91-95%) on disability-free survival in extremely preterm infants.
- To analyze hospital discharge outcomes in infants born before 28 weeks' gestation.
Main Methods:
- Three international randomized controlled trials involving 2448 preterm infants were analyzed.
- Oxygen saturation targeting groups were 85-89% versus 91-95%.
- Oximeter-calibration algorithm was revised mid-study, and data were pooled for analysis.
Main Results:
- With a revised oximeter algorithm, the lower oxygen saturation target group had a significantly higher mortality rate (23.1% vs. 15.9%).
- Overall, lower oxygen saturation targets reduced retinopathy of prematurity (10.6% vs. 13.5%) but increased necrotizing enterocolitis (10.4% vs. 8.0%).
- Mortality showed heterogeneity between original and revised oximeter algorithms (P=0.006).
Conclusions:
- Targeting oxygen saturation below 90% in extremely preterm infants using current oximeters is linked to an increased risk of death.
- The findings highlight a critical trade-off between reducing retinopathy of prematurity and increasing risks of mortality and necrotizing enterocolitis.
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