Oxygen Saturation Targets for Extremely Preterm Infants after the NeOProM Trials

Area of Science:

• Neonatal Medicine
• Critical Care
• Pediatric Pulmonology

Background:

• Extremely preterm infants often require supplemental oxygen to maintain adequate pulse oximeter saturation (SpO2).
• Debate exists regarding optimal SpO2 target ranges to balance benefits and risks, including mortality and neurodevelopmental outcomes.

Purpose of the Study:

• To compare the clinical outcomes of extremely preterm infants assigned to lower (85-89%) versus higher (91-95%) SpO2 target ranges.
• To evaluate the impact of different SpO2 targets on mortality, disability, bronchopulmonary dysplasia, and necrotizing enterocolitis.

Main Methods:

• Individual patient data meta-analysis of five randomized controlled trials involving over 4,800 extremely preterm infants.
• Comparison of outcomes between infants randomized to lower versus higher SpO2 target ranges.

Main Results:

• The lower SpO2 target range (85-89%) was associated with a significant increase in the risk of death compared to the higher range (91-95%).
• No significant difference in disability rates at 18-24 months, including blindness, was observed between the groups.
• The lower target range increased the risk of necrotizing enterocolitis requiring surgery or causing death and did not reduce bronchopulmonary dysplasia or severe visual impairment.

Conclusions:

• Current evidence does not support SpO2 targets below 90% for extremely preterm infants due to increased mortality and other morbidities.
• Further trials are warranted to determine if higher SpO2 targets (above 95%) could offer additional survival advantages.
• The Neonatal Oxygen Prospective Meta-Analysis (NeOProM) may provide further insights into optimal oxygen management in this vulnerable population.