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Published on: August 25, 2014
Neuropsychological Outcomes in Extremely Preterm Preschoolers Exposed to Tiered Low Oxygen Targets: An Observational
Ida Sue Baron1, Brandi A Weiss2, Robin Baker1
11Fairfax Neonatal Associates,Inova Children's Hospital,Falls Church,Virginia.
Insights
This study compared neuropsychological outcomes in extremely preterm infants using tiered versus non-tiered oxygen saturation targets. The tiered approach showed potential benefits in cognitive and motor functions, warranting further research.
Area of Science:
- Neonatal Medicine
- Neurodevelopmental Pediatrics
- Clinical Research
Background:
- Extremely preterm infants (<28 weeks' gestational age) face risks of neurodevelopmental impairments.
- Oxygen saturation targets in neonates have evolved, with tiered approaches proposed to optimize outcomes.
- Previous strategies lacked specific targets for different postmenstrual ages.
Purpose of the Study:
- To evaluate the association between tiered oxygen saturation targets and preschool-age neuropsychological outcomes in extremely preterm neonates.
- To compare cognitive, executive, attention, language, and motor functioning between infants exposed to tiered versus non-tiered oxygen saturation protocols.
- To investigate potential benefits of tiered oxygen saturation in extremely preterm infants, particularly those born at 23-24 weeks' gestation.
Main Methods:
- Observational study of 111 extremely preterm infants assessed at age 3.
- Comparison between a 'TieredO2' group (2009-2010) with stratified oxygen targets and a 'Non-tieredO2' group (2007-2008) with standard targets (89-100%).
- Neuropsychological assessment across multiple domains including general intellect, executive function, attention, language, and motor skills.
Main Results:
- No statistically significant group differences in overall neuropsychological outcomes.
- Descriptively, the TieredO2 group showed better general intellectual, executive, visual-motor, and motor performance.
- The TieredO2 group experienced fewer ventilation days and less bronchopulmonary dysplasia, potentially influencing outcomes.
Conclusions:
- The tiered oxygen saturation target strategy appears safe and potentially beneficial for neuropsychological development in extremely preterm infants.
- Further research is warranted to confirm these findings and explore the mechanisms behind observed benefits, especially in the most vulnerable infants.
- Reduced respiratory support and lower bronchopulmonary dysplasia rates in the tiered group may contribute to improved neurodevelopmental trajectories.
Abstract:
An observational study of neuropsychological outcomes at preschool age of tiered lowered oxygen (O2) saturation targets in extremely preterm neonates. We studied 111 three-year-olds born <28 weeks' gestational age. Fifty-nine participants born in 2009-2010 during a time-limited quality improvement initiative each received three-tiered stratification of oxygen rates (83-93% until age 32 weeks, 85-95% until age 35 weeks, and 95% after age 35 weeks), the TieredO2 group. Comparisons were made with 52 participants born in 2007-2008 when pre-initiative saturation targets were non-tiered at 89-100%, the Non-tieredO2 group. Neuropsychological domains included general intellectual, executive, attention, language, visuoperceptual, visual-motor, and fine and gross motor functioning. Descriptive and inferential analyses were conducted. Group comparisons were not statistically significant. Descriptively, the TieredO2 group had better general intellectual, executive function, visual-motor, and motor performance and the Non-tieredO2 group had better language performance. Cohen's d and confidence intervals around d were in similar direction and magnitude across measures. A large effect size was found for recall of digits-forward in participants born at 23 and 24 weeks' gestation, d=0.99 and 1.46, respectively. Better TieredO2 outcomes in all domains except language suggests that the tiered oxygen saturation target method is not harmful and merits further investigation through further studies. Benefit in auditory attention appeared greatest in those born at 23 and 24 weeks. Participants in the tiered oxygen saturation group also had fewer ventilation days and a lower incidence of bronchopulmonary dysplasia, perhaps explanatory for these neuropsychological outcomes at age 3.
