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Lower early postnatal oxygen saturation target and risk of ductus arteriosus closure failure

Kei Inomata1, Shinji Taniguchi1, Hiroki Yonemoto1

  • 1Department of Neonatology, Perinatal Center, Kumamoto City Hospital, Kumamoto City, Kumamoto, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|March 23, 2016
PubMed

Insights

A lower oxygen saturation target range (85-92%) in premature infants increased the risk of ductus arteriosus (DA) closure failure and hypoxemia. This finding highlights potential risks associated with managing oxygen levels in extremely preterm newborns.

Area of Science:

  • Neonatal Medicine
  • Pediatric Cardiology
  • Critical Care

Background:

  • Early postnatal hyperoxia is a significant risk factor for retinopathy of prematurity (ROP) in extremely premature infants.
  • A lower target range for oxygen saturation (SpO2) of 85-92% was implemented in April 2011 to reduce ROP incidence.
  • This lower SpO2 range may increase the risk of hypoxemia and ductus arteriosus (DA) closure failure.

Purpose of the Study:

  • To investigate if a lower early postnatal SpO2 target range increases the risk of DA closure failure.
  • To evaluate the association between reduced SpO2 targets and adverse neonatal outcomes.

Main Methods:

  • Retrospective cohort study comparing two periods with different SpO2 target ranges.
  • Infants born at <28 weeks' gestation were analyzed.
  • Period 1: SpO2 target 84-100%; Period 2: SpO2 target 85-92% during the first 72 postnatal hours.

Main Results:

  • The lower SpO2 target range (Period 2) was associated with increased hypoxemia.
  • DA closure failure prevalence was significantly higher in Period 2 (21%) compared to Period 1 (1%).
  • Multivariate logistic regression identified the lower SpO2 target range as an independent risk factor for DA closure failure.

Conclusions:

  • Lowering the early postnatal SpO2 target range in extremely premature infants increases the risk of DA closure failure.
  • Clinical practice guidelines for oxygen management in preterm infants require careful consideration of this risk.
  • Further research is needed to optimize SpO2 targets to balance ROP prevention and other critical outcomes.
Abstract

Keywords:
ductus arteriosus ligationextremely premature infanthypoxemiaoxygen saturationpatent ductus arteriosus

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