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Published on: November 20, 2015
Association between intermittent hypoxemia and neurodevelopmental outcomes in extremely premature infants: A
Faith Kim1, David A Bateman1, Donna Garey2
1Department of Pediatrics, NewYork Presbyterian Morgan Stanley Children's Hospital/Columbia University Irving Medical Center, New York, NY, United States of America.
Insights
Intermittent hypoxemic events (IHEs) in extremely premature infants are linked to neurodevelopmental issues. Each hour of low oxygen exposure (SpO2 ≤ 80%) increased the odds of severe neurodevelopmental impairment (SNDI) by 2.7%.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Critical Care
Background:
- Extremely premature infants face significant risks for adverse neurodevelopmental outcomes.
- Intermittent hypoxemic events (IHEs), characterized by low oxygen saturation, are common in this vulnerable population.
- The precise association between IHEs and neurodevelopmental impairment or mortality requires further elucidation.
Purpose of the Study:
- To investigate the relationship between intermittent hypoxemic events (IHEs) and severe neurodevelopmental impairment (SNDI) or death in extremely premature infants.
- To quantify the impact of hypoxic burden on neurodevelopmental outcomes in this cohort.
Main Methods:
- Retrospective study of extremely premature infants (23-27 weeks gestational age) admitted to a level IV NICU.
- IHEs defined as SpO2 ≤ 80% for 10 seconds to 5 minutes, identified algorithmically.
- Mixed-effects and logistic regression models used to assess the association between IHEs and outcomes (SNDI or death) at 18-24 months corrected age.
Main Results:
- The overall mortality rate was 7%.
- Severe neurodevelopmental impairment (SNDI) occurred in 34% of infants with available data.
- Total duration of IHEs, but not the daily rate, was significantly associated with increased odds of SNDI, even after adjusting for gestational age.
Conclusions:
- Each hour of total IHE duration (SpO2 ≤ 80%) was associated with a 2.7% increase in the odds of SNDI at 18-24 months corrected age.
- Findings highlight the detrimental impact of cumulative hypoxic exposure on neurodevelopment in extremely premature infants.
- Strategies to minimize IHEs may be crucial for improving long-term neurodevelopmental outcomes in this population.
Objective:
To describe the association between intermittent hypoxemic events (IHEs) and severe neurodevelopmental impairment (SNDI) or death in extremely premature infants.
Study Design:
Retrospective study of extremely premature infants 230/7-276/7 weeks gestational age (GA) and birthweight (BW) ≤1250 grams (g) admitted to a level IV neonatal intensive care unit (NICU) from 2013 to 2017. IHEs, defined as events with SpO2 ≤ 80 % lasting 10 s to 5 min, were algorithmically identified using data extracted from bedside monitors at 2 s intervals (0.5 Hz). The primary outcome was SNDI at 18-24 months corrected age (CA), defined as a Bayley-III motor, language or cognitive composite score ≤69, or death before discharge while the secondary outcome was SNDI alone. We used mixed-effects regression models to evaluate the relationship between mean daily IHE rate per postnatal week of life for the first 12 weeks and the outcomes, and logistic regression models to assess the association between outcomes and summary measures of hypoxic burden for the entire NICU hospitalization.
Results:
The mortality rate was 7 % (18/249) during NICU hospitalization. Of 249 infants born during this time period, IHE and neurodevelopmental outcome data were fully available for 65 infants (mean GA 26 ± 1.4 weeks, mean birth weight (BW) 738 ± 199 g. The outcome of SNDI alone occurred in 34 % (22/65) with a majority demonstrating motor or language delay on the Bayley-III. Although mean daily IHE rate/week was not associated with SNDI or death, total IHE duration was associated with increased odds of SNDI (OR (95 % CI) 1.03 (1.01, 1.05), p = 0.008) in models adjusted for GA.
Conclusions:
In a cohort of extremely premature infants 23-27 weeks GA, each hour of total IHE duration (SpO2 ≤ 80 %) was associated with a 2.7 % (0.7 %, 4.8 %) increase in the odds of SNDI at 18-24 months CA.
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