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Eliminating sleep-associated hypoxemia improves growth in infants with bronchopulmonary dysplasia
L J Moyer-Mileur1, D W Nielson, K D Pfeffer
1Department of Pediatrics, University of Utah, Salt Lake City 84132, USA.
Insights
Short-term oxygen saturation tests do not predict sleep levels in infants with bronchopulmonary dysplasia (BPD). Maintaining oxygen saturation above 92% during sleep supports positive growth, while lower levels impede it.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
Background:
- Infants with bronchopulmonary dysplasia (BPD) often experience decreased growth velocity after supplemental oxygen (SO) cessation.
- Oxygen saturation (Sao2) can decrease during sleep and feeding in BPD infants.
- Current practices for SO discontinuation rely on short-term awake Sao2 measurements.
Purpose of the Study:
- To determine if short-term, awake Sao2 reliably predicts prolonged sleep Sao2 in BPD infants.
- To assess the impact of sustained Sao2 levels (88-91% vs. >=92%) on growth velocity after SO discontinuation.
Main Methods:
- Prospective comparison of short-term awake Sao2 with prolonged sleep Sao2 in 63 infants.
- Analysis of growth velocity in infants with SO discontinued based on prolonged sleep Sao2 thresholds (88-91% vs. >=92%).
Main Results:
- Short-term awake Sao2 did not correlate with prolonged sleep Sao2 (r = .02).
- Infants with sleep Sao2 >=92% maintained growth velocity after SO cessation.
- Infants with sleep Sao2 88-91% exhibited a significant decrease in weight gain rate and z scores.
Conclusions:
- Short-term awake Sao2 measurements are unreliable predictors of prolonged sleep Sao2 in BPD infants.
- Sustaining Sao2 >=92% during prolonged sleep is crucial for maintaining positive growth trends in BPD infants.
- Discontinuation of SO should consider prolonged sleep Sao2 monitoring rather than short-term awake measurements.
Objective:
Infants with bronchopulmonary dysplasia (BPD) have been previously reported to have a decrease in growth velocity after stopping supplemental oxygen (SO). SO was stopped after a short-term recording (20-30 minutes) of pulse oxygen saturation (Sao2) of 92% or greater in room air. Other studies have documented that Sao2 decreases further during feedings and sleep in infants with BPD. Two questions were asked: (1) whether short-term, awake Sao2 studies would reliably predict prolonged sleep Sao2; and (2) how Sao2 sustained at 88% to 91% vs 92% or greater in room air would impact growth velocity in infants with BPD.
Methodology:
Short-term Sao2 studies were prospectively compared with prolonged sleep Sao2 (n = 63) and the growth velocity of infants who had SO discontinued after a prolonged sleep Sao2 recording of 88% to 91% (group 1; n = 14) versus 92% or greater (group 2; n = 34) in room air.
Results:
Failure to maintain Sao2 at predetermined levels occurred in 18 (29%) of 63 infants during their first prolonged sleep study. There was no correlation between short-term awake Sao2 and prolonged sleep Sao2 recordings (r = .02). Body weight, height, weight for height, and rate of weight gain were similar for all study infants before SO was stopped and remained constant for group 2 infants after SO was stopped. However, group 1 infants had a significant decrease in the rate of weight gain (17.3 +/- 13.1 vs 3.7 +/- 6.1 g/kg per day), and the mean z scores for weight gain and weight for height also decreased significantly for group 1 infants. Energy intake, incidence of acute infection, hematocrit values, and medication use did not differ before or after stopping SO in either group.
Conclusions:
This study indicated that short-term, awake Sao2 measurements do not predict prolonged sleep Sao2, and overall, infants with BPD continued a positive growth trend when Sao2, remained greater than 92% during prolonged sleep.