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Patterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort
Juliann M Di Fiore1, Richard J Martin1, Hong Li2
1Division of Neonatology, Rainbow Babies & Children's Hospital, Department of Pediatrics, Case Western Reserve University, Cleveland, OH.
Insights
Extremely preterm infants, especially those small for gestational age (SGA), experienced lower oxygen saturation and higher hypoxemia with lower oxygen targets. Lower oxygen saturation and increased hypoxemia events were linked to reduced survival in SGA infants.
Area of Science:
- Neonatal care
- Pediatric intensive care
- Respiratory physiology
Background:
- Oxygen saturation targets in extremely preterm infants remain a critical area of research.
- Infants born small for gestational age (SGA) may have different physiological responses to oxygen therapy.
- The Surfactant Positive Pressure and Oxygen Trial (SuPPO Trial) investigated optimal oxygenation strategies.
Purpose of the Study:
- To analyze achieved oxygenation patterns in infants appropriate vs. small for gestational age (SGA) randomized to lower vs. higher oxygen saturation targets.
- To determine the relationship between achieved oxygen saturation levels and 90-day survival in these infants.
Main Methods:
- Analysis of oxygen saturation and intermittent hypoxemia events (<80% for 20 seconds to 5 minutes) in 1054 infants (24-27 weeks gestation) over the first 3 days of life.
- Comparison of outcomes between infants randomized to lower (85-89%) and higher (91-95%) oxygen saturation targets.
- Assessment of 90-day survival rates.
Main Results:
- Infants randomized to lower oxygen targets who were SGA had the lowest oxygen saturation and highest incidence of hypoxemia.
- Lowest quartile of oxygen saturation (≤92%) was associated with reduced 90-day survival for both appropriate and SGA infants.
- Increased hypoxemia events were linked to lower 90-day survival specifically in SGA infants.
Conclusions:
- Lower achieved oxygen saturation in the first 3 days of life is associated with decreased 90-day survival in extremely preterm infants.
- Small for gestational age (SGA) infants exhibit increased vulnerability to lower oxygen saturation targets, with higher hypoxemia correlating to lower survival.
Objective:
To characterize actual achieved patterns of oxygenation in infants born appropriate vs small for gestational age (SGA) randomized to a lower (85-89%) vs higher (91%-95%) oxygen saturation target in the Surfactant Positive Pressure and Oxygen Trial. To determine the association between achieved oxygen saturation levels and survival in infants born appropriate vs SGA enrolled in the Surfactant Positive Pressure and Oxygen Trial.
Study Design:
Median oxygen saturation and intermittent hypoxemia events (<80%, 20 seconds-5 minutes) were documented in 1054 infants of 240/7-276/7 weeks of gestation while receiving supplemental oxygen during the first 3 days of life.
Results:
Lower target infants who were small for gestational age had the lowest oxygen saturation and highest incidence of intermittent hypoxemia during the first 3 days of life. The lowest quartile of oxygen saturation (≤92%) during the first 3 days of life was associated with lower 90-day survival for both infants born appropriate and SGA. An increased incidence of intermittent hypoxemia events during the first 3 days of life was associated with lower 90-day survival only in infants born SGA.
Conclusion:
Lower achieved oxygen saturation during the first 3 days of life was associated with lower 90-day survival in extremely preterm infants. Infants born SGA had enhanced vulnerability to lower oxygen saturation targets as evidenced by lower achieved oxygen saturation and an association between increased intermittent hypoxemia events and lower survival.
Trial Registration:
ClinicalTrials.gov: NCT00233324.
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