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Oxygen Saturation Targets in Preterm Infants and Outcomes at 18-24 Months: A Systematic Review
Veena Manja1,2, Ola D Saugstad3, Satyan Lakshminrusimha4
1Division of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Buffalo, New York.
Insights
Lowering the oxygen saturation target for extremely preterm infants did not improve outcomes. Restricting the upper limit to 89% increased mortality, suggesting higher targets may be safer.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Optimal oxygen saturation targets for extremely preterm infants are not well-established.
- Current guidelines vary, leading to different clinical practices.
Purpose of the Study:
- To systematically review evidence comparing lower (85%-89%) versus higher (91%-95%) pulse oxygen saturation (SpO2) targets.
- To evaluate the impact on mortality and neurodevelopmental impairment (NDI) in preterm infants.
Main Methods:
- Systematic review of published randomized trials.
- Included 5 trials with 2896 infants.
- Analyzed data for mortality and NDI at 18-24 months.
Main Results:
- No significant difference in the primary outcome (death/NDI) between lower and higher SpO2 target groups (RR 1.05, P=.18).
- Mortality before 18-24 months was higher in the lower-target group (RR 1.16, P=.02).
- No differences in NDI or severe visual loss rates were observed.
Conclusions:
- No difference in the primary outcome between SpO2 target groups.
- Risks of restricting the upper SpO2 limit to 89% appear to outweigh benefits.
- Moderate quality evidence suggests caution with lower targets; wider ranges may warrant further study.
Context:
The optimal oxygen saturation target for extremely preterm infants remains unclear.
Objective:
To systematically review evidence evaluating the effect of lower (85%-89%) versus higher (91%-95%) pulse oxygen saturation (Spo2) target on mortality and neurodevelopmental impairment (NDI) at 18 to 24 months.
Data Sources:
Electronic databases and all published randomized trials evaluating lower versus higher Spo2 target in preterm infants.
Study Selection:
A total of 2896 relevant citations were identified; 5 trials were included in the final analysis.
Data Extraction:
Data from 5 trials were analyzed for quality of evidence and risk of bias.
Limitations:
Limitations include heterogeneity in age at enrollment and comorbidities between trials and change in oximeter algorithm midway through 3 trials.
Results:
There was no difference in the incidence of primary outcome (death/NDI at 18-24 months) in the 2 groups; risk ratio,1.05, 95% confidence interval 0.98-1.12, P = .18. Mortality before 18 to 24 months was higher in the lower-target group (risk ratio,1.16, 95% confidence interval 1.03-1.31, P = .02). Rates of NDI and severe visual loss did not differ between the 2 groups. Proportion of time infants spent outside the target range while on supplemental oxygen ranged from 8.2% to 27.4% <85% and 8.1% to 22.4% >95% with significant overlap between the 2 groups.
Conclusions:
There was no difference in primary outcome between the 2 Spo2 target groups. The collective data suggest that risks associated with restricting the upper Spo2 target limit to 89% outweigh the benefits. The quality of evidence was moderate. We speculate that a wider target range (lower alarm limit, 89% and upper, 96%) may increase time spent within range, but the safety profile of this approach remains to be determined.
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