In Search of the Optimal Oxygen Saturation for Extremely Low Birth Weight Infants: A Systematic Review and Meta-Analysis

Saugstad, Ola Didrik; Aune, Dagfinn

doi:10.1159/000322001

Cited by 92 publications

(66 citation statements)

References 71 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Higher SpO 2 targets may induce stable sleep patterns and better long-term growth and development (32), but at the cost of retinopathy of prematurity, bronchopulmonary dysplasia, and brain injury (33,34). Alternately, the use of "restrictive" oxygen therapy has been found to produce a negative effect on the survival, cognitive functions, adaptive skills and behavior (35).…”

Section: Discussionmentioning

confidence: 99%

Effect of oxygen inhalation on cerebral blood flow velocity in premature neonates

et al. 2013

View full text Add to dashboard Cite

Background:The study tested the hypothesis that hyperoxemia and hypoxemia differentially alter cerebral blood flow velocity (CBFV) in a gestational age-dependent manner. Methods: Cases comprised 98 neonates with mild respiratory distress, receiving oxygen for >24 h in first 48 h of life. Ninety-eight age-and-weight-matched healthy neonates served as controls. Infants with perinatal asphyxia, shock, sepsis, malformations, acidosis/alkalosis, and hypo/hypercarbia were excluded. Resistance index (RI), pulsatility index (PI), peak systolic flow velocity (PSV), and vascular diameter were measured in internal carotid, vertebral, and middle cerebral arteries by transcranial doppler ultrasonography between 24 and 48 h of life with immediate postdoppler arterial blood gas analysis. For subgroup analysis, neonates were divided by gestational age and PaO 2 . results: An overall decrease in RI/PI and increase in PSV and vasodilation was observed in cases. Hyperoxemia (PaO 2 >90 mm Hg) was more common in premature neonates. Neonates <32 wk showed an increase in CBFV (decreased RI/PI and increased PSV/diameter) in association with hyperoxemia. An opposite response was observed in neonates ≥32 wk, where CBFV increased in response to hypoxemia (PaO 2 <50 mm Hg) and decreased in hyperoxemia. Increased CBFV showed high predictive accuracy for immediate mortality and intracranial hemorrhage. conclusion: Depending on gestational maturity, hyperoxemia or hypoxemia produce differential effects in CBFV.

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of oxygen inhalation on cerebral blood flow velocity in premature neonates

et al. 2013

View full text Add to dashboard Cite

show abstract

“…Recently, a randomized study confirmed that a low oxygen saturation (85–89%) compared with a high (91–95%) reduces ROP [95]. In a recent systematic review, we showed that a low SpO 2 reduces severe ROP by more than 50% and BPD by 20–25% [96]. Unfortunately, it seems that mortality is also significantly increased if babies <29 weeks’ gestation are kept in SpO 2 between 85 and 89% compared with 91–95% [95,97].…”

Section: Oxygenation Of Term and Preterm Newborn Infantsmentioning

confidence: 94%

Oxygenation of the Newborn: A Molecular Approach

Saugstad

Sejersted²,

Solberg³

et al. 2012

Neonatology

Self Cite

View full text Add to dashboard Cite

In this review oxygenation and hyperoxic injury of newborn infants are described through molecular and genetic levels. Protection and repair mechanisms that may be important for a new understanding of oxidative stress in the newborn are discussed. The research summarized in this article represents a basis for the reduced oxygen supplementation and oxidative load of newborn babies, especially since the turn of the century. The mechanisms discussed may also contribute to an understanding of why hyperoxic resuscitation of the newborn may damage DNA and affect its repair, thus increasing the risk that it may be carcinogenic. Today, term babies should be resuscitated with air rather than 100% oxygen and very and extremely low birth weight infants in need of stabilization or resuscitation at birth should be administered initially 21–30% oxygen and the level should be titrated according to the response, preferably measured by pulse oximetry. In the postnatal period the oxygen saturation should be targeted low <95%; however, saturations between 85 and 89% seem to increase mortality. The optimal oxygen saturation target for these infants postnatally is still unknown.

show abstract

“…In the following years, several cohort studies all strongly indicated that a lower SpO 2 target is preferable compared with a high target [15,16,17,18,19,20,21]. We summarized these studies and found a more than 50% significant reduction in severe ROP and a 20-25% reduction in bronchopulmonary dysplasia (BPD)/chronic lung disease when the SpO 2 target was low compared to high [22]. No difference in mortality was detected by any of these studies including two systematic reviews and meta-analysis [22,23].…”

Section: Introductionmentioning

confidence: 99%

Optimal Oxygenation of Extremely Low Birth Weight Infants: A Meta-Analysis and Systematic Review of the Oxygen Saturation Target Studies

Saugstad

Aune²

2013

Neonatology

Self Cite

264

217

View full text Add to dashboard Cite

Background: The optimal oxygen saturation for extremely low birth weight infants in the postnatal period beyond the delivery room is not known. Objectives: To summarize and discuss the results of the randomized trials, constituting the NEOPROM (Neonatal Oxygenation Prospective Meta-analysis) collaborative study, examining the effect of low versus high functional oxygen saturation targets in the postnatal period in premature infants with gestational age <28 weeks. Methods: A meta-analysis of SUPPORT (Surfactant, Positive Pressure and Pulse Oximetry Randomized Trial), the three BOOST II (Benefits of Oxygen Saturation Targeting) studies and the COT (Canadian Oxygen Trial) was performed including a total of 4,911 infants randomized to either a low (85-89%) or high (91-95%) functional oxygen saturation (SpO₂) within the first 24 h after birth. Results: Relative risks (RR; 95% CIs) comparing a low versus a high oxygen saturation target were 1.41 (1.14-1.74) for mortality at discharge or at follow-up, 0.74 (0.59-0.92) for severe retinopathy of prematurity, 0.95 (0.86-1.04) for physiologic bronchopulmonary dysplasia, 1.25 (1.05-1.49) for necrotizing enterocolitis, 1.02 (0.88-1.19) for brain injury, and 1.01 (0.95-1.08) for patent ductus arteriosus. RR >1.0 favors a high oxygen saturation. Conclusions: RRs for mortality and necrotizing enterocolitis are significantly increased and severe retinopathy of prematurity significantly reduced in low compared to high oxygen saturation target infants. There are no differences regarding physiologic bronchopulmonary dysplasia, brain injury or patent ductus arteriosus between the groups. Based on these results, it is suggested that functional SpO₂ should be targeted at 90-95% in infants with gestational age <28 weeks until 36 weeks' postmenstrual age. However, there are still several unanswered questions in this field.

show abstract

In Search of the Optimal Oxygen Saturation for Extremely Low Birth Weight Infants: A Systematic Review and Meta-Analysis

Cited by 92 publications

References 71 publications

Effect of oxygen inhalation on cerebral blood flow velocity in premature neonates

Effect of oxygen inhalation on cerebral blood flow velocity in premature neonates

Oxygenation of the Newborn: A Molecular Approach

Optimal Oxygenation of Extremely Low Birth Weight Infants: A Meta-Analysis and Systematic Review of the Oxygen Saturation Target Studies

Contact Info

Product

Resources

About