Avoiding hyperoxia in infants ⩽1250?g is associated with improved short- and long-term outcomes

Abstract

Objective: To determine the rate and severity of short-and long-term morbidity in very low birth weight infants treated before and after the implementation of a change in clinical practice designed to avoid hyperoxia.Methods: Analysis of a prospectively collected database of all infants p1250 g

Clinical practices in neonatal oxygenation: where have we failed? What can we do?

“…We have recently shown that changing SpO 2 saturation targets, to try to avoid hyperoxia, resulted in a decrease in BPD from 51 to 35% (P<0.001) in infants <1250 g who received IMV and oxygen therapy. 18,40 The practice was also associated with decreased LOS from 85.9 ± 40 to 76.5 ± 37.7 days (P ¼ 0.01). 40 This change in practice was not associated with worse survival or morbidity rates of PDA, NEC, IVH or PVL.…”

“…18,40 The practice was also associated with decreased LOS from 85.9 ± 40 to 76.5 ± 37.7 days (P ¼ 0.01). 40 This change in practice was not associated with worse survival or morbidity rates of PDA, NEC, IVH or PVL. This change in practice, did not have a detrimental effect on neurodevelopmental outcomes at 18 months corrected age, but the Bayley scores actually improved.…”

“…Tight SpO 2 control with modern monitoring (Masimo SET) markedly reduced the development of stages 3 and 4 ROP and the need for laser therapy in infants 500 to 1500 g. 39 Recently, we reported improvement in ROP rates when avoiding hyperoxia in infants <1250 g at two different centers and investigated if the effect of this practice was associated with worsening short term outcomes and long term neurodevelopment. 40 At the time of these prospective studies, there were surveys or cohort studies that also supported an association with less ROP in different centers utilizing different SpO2 targets. [41][42][43] Recently, several studies [44][45][46] have confirmed our findings.…”

Improved growth and decreased morbidities in <1000 g neonates after early management changes

“…8 Not only does this intervention appear safe, but the 'STOP-ROP' (supplemental therapeutic oxygen for pre-threshold retinopathy of prematurity) trial demonstrated that lowered oxygen saturations decreased adverse pulmonary events, such as pneumonia and the need for supplemental oxygen. 9 A recent study has demonstrated a reduction in the incidence of bronchopulmonary dysplasia (BPD) with lowered oxygen saturation goals.…”

“…9 A recent study has demonstrated a reduction in the incidence of bronchopulmonary dysplasia (BPD) with lowered oxygen saturation goals. 8 Oxygen toxicity may be a significant factor in the etiology of neuronal injury 7 and its role in growth has not been closely examined.…”