Effect of the Target Range on Arterial Oxygen Saturation Stability in Extremely Premature Infants
Waleed Kurtom1, Alaleh Dormishian2,3, Deepak Jain4
1Division of Neonatology, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Insights
Targeting lower oxygen saturation (SpO2) in premature infants increased hypoxemia, while higher targets raised hyperoxemia risks. This trade-off requires further study for optimal infant respiratory support.
Area of Science:
- Neonatology
- Pediatric Critical Care
- Respiratory Physiology
Background:
- Extremely premature infants often require respiratory support.
- Maintaining optimal arterial oxygen saturation (SpO2) is crucial for preventing complications.
Purpose of the Study:
- To compare the effects of targeting high (93-95%) versus low (90-92%) SpO2 ranges on oxygenation stability in extremely premature infants.
Main Methods:
- Infants born at ≤28 weeks gestational age receiving fraction of inspired oxygen (FiO2) > 0.21 after day 14 were included.
- SpO2 was targeted to 90-92% and 93-95% for 2-hour periods each, in random sequence.
- Intermittent hypoxemia (IH) and hyperoxemia were defined and quantified.
Main Results:
- Episodes of IH and severe IH were significantly more frequent when targeting the lower SpO2 range (90-92%).
- The high SpO2 target (93-95%) resulted in a greater proportion of time with SpO2 >95% and >98%, indicating increased hyperoxemia.
Conclusions:
- Targeting the lower end of the recommended SpO2 range in extremely premature infants leads to more frequent hypoxemic events.
- Conversely, targeting the higher end increases the risk of hyperoxemia, presenting a critical balance for clinical management.
Objective:
The aim of this study was to compare the effect of targeting arterial oxygen saturation (SpO2) in the high (93-95%) versus the low portion (90-92%) of the recommended range of 90-95% on oxygenation stability in extremely premature infants.
Methods:
Premature infants of ≤28 weeks of gestational age who received a fraction of inspired oxygen (FiO2) > 0.21 after day 14 were eligible. FiO2 was adjusted by a dedicated investigator to keep SpO2 between 90-92% and 93-95% for 2 h each in random sequence. Episodes of intermittent hypoxemia (IH) were defined as SpO2 <90% for ≥10 s; severe IH episodes were defined as SpO2 <80% for ≥10 s. Hyperoxemia was defined as SpO2 >95% or >98%.
Results:
Eighteen premature infants were enrolled. Their (mean ± SD) GA was 26 ± 1.5 w. Seven infants were on mechanical ventilation, 4 infants on nasal ventilation, and 7 infants on nasal cannula. They were on a mean FiO2 0.38 ± 0.12 at study entry. Episodes of IH and severe IH were more frequent during the low compared to the high target (36.6 [27.0-41.3] vs. 16.0 [7.8-19.0], p < 0.001; 8.4 ± 9.3 vs. 3.2 ± 4.3, p = 0.002). The proportions of time with SpO2 >95% and >98% were greater with the high target (13.9 ± 11 vs. 34.1 ± 15.4%, p < 0.001; 0.9 [0-5.7] vs. 3.4 [0.5-16.1]%, p = 0.002).
Conclusion:
In this group of extremely premature infants, targeting SpO2 at the lower portion of the recommended range resulted in more frequent episodes of IH. However, targeting the higher SpO2 range led to more hyperoxemia. This trade-off warrants further investigation.
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