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Pulse Oximetry Targets in Extremely Premature Infants and Associated Mortality: One-Size May Not Fit All

Thomas M Raffay1, Michele C Walsh1

  • 1Department of Pediatrics, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA.

Journal of Nature and Science
|June 26, 2018
PubMed

Insights

Targeting lower oxygen saturation levels (85-89%) in premature infants may increase mortality, particularly in small for gestational age infants. Further research is needed to understand patient-specific risks.

Area of Science:

  • Neonatal Medicine
  • Pediatric Critical Care
  • Respiratory Physiology

Background:

  • Oxygen saturation targets for premature infants are debated, with varying results from randomized controlled trials.
  • Some studies indicate higher mortality with lower oxygen saturation ranges (85-89%) compared to higher ranges (91-95%).
  • Other trials have not found a significant difference in mortality based on oxygen saturation targets.

Purpose of the Study:

  • To review mortality outcomes from major international randomized controlled trials on oxygen saturation targets in premature infants.
  • To analyze a post hoc study that identified increased mortality in small for gestational age infants at lower oxygen saturation targets.
  • To highlight the potential of the Neonatal Oxygen Prospective Meta-analysis (NeOProM) to clarify patient-specific risks, including growth status.

Main Methods:

  • Systematic review of mortality data from large, multi-centered international randomized controlled trials.
  • Analysis of a post hoc study examining mortality in relation to oxygen saturation targets and infant growth status.
  • Prospective meta-analysis planned through the NeOProM collaborative.

Main Results:

  • Conflicting evidence exists regarding the association between lower oxygen saturation targets and infant mortality.
  • A post hoc analysis suggests a potential increase in mortality among small for gestational age infants at lower target ranges.
  • The impact of patient-specific factors, such as growth status, on mortality requires further investigation.

Conclusions:

  • The optimal oxygen saturation target for premature infants remains an area of active research and clinical consideration.
  • Lower oxygen saturation targets may pose a higher risk for specific subgroups, such as small for gestational age infants.
  • Future research, including meta-analyses like NeOProM, is crucial for refining individualized oxygen management strategies in neonates.

Keywords:
GrowthMortalityNeonatalOxygen saturationPrematurity

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