Patterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort

Fiore, Juliann M. Di; Martin, Richard J.; Li, Hong; Morris, Nathan; Carlo, Waldemar A.; Finer, Neil N.; Walsh, Michele C.; Jobe, Alan H.; Caplan, Michael S.; Polin, Richard A.; Laptook, Abbot R.; Oh, William; Hensman, Angelita M.; Gingras, Dan; Barnett, Susan; Lillie, Sarah E.; Kim, Francis; Andrews, Dawn; Angela, Kristen; Fanaroff, Avroy A.; Newman, Nancy S.; Siner, Bonnie S.; Zadell, Arlene; Schibler, Kurt; Donovan, Edward F.; Bridges, Kate; Alexander, Barbara; Grisby, Cathy; Mersmann, Marcia Worley; Mincey, Holly L.; Hessling, Jody; Goldberg, Ronald N.; Cotten, C. Michael; Wallace, David K.; Freedman, Sharon F.; Auten, Kathy J.; Fisher, Kimberly A.; Foy, Katherine A.; Stoll, Barbara J.; Piazza, Anthony J.; Buchter, Susie; Carlton, David P.; Hutchinson, Amy K.; Hale, Ellen C.; Higgins, Rosemary D.; Archer, Stephanie Wilson; Poindexter, Brenda B.; Lemons, James A.; Hamer, Faithe; Herron, Dianne E.; Miller, Lucy; Wilson, Leslie D.; Berberich, Mary Anne; Blaisdell, Carol J.; Gail, Dorothy B.; Kiley, James P.; Gantz, Marie G.; Das, Abhik; Crawford, Margaret; Hastings, Betty K.; Irene, Amanda R.; Auman, Jeanette O’Donnell; Huitema, Carolyn Petrie; Pickett, James W.; Wallace, Dennis; Zaterka-Baxter, Kristin M.; Meurs, Krisa P. Van; Stevenson, David K.; Ball, Michelle; Proud, Melinda S.; Frantz, Ivan D.; Fiascone, John M.; Furey, Anne; MacKinnon, Brenda; Nylen, Ellen; Ambalavanan, Namasivayam; Collins, Monica V.; Cosby, Shirley S.; Phillips, Vivien A.; Rasmussen, Maynard; Wozniak, Paul R.; Rich, Wade; Arnell, Kathy; Bridge, Renee; Demetrio, Clarence; Bell, Edward F.; Widness, John A.; Klein, Jonathan M.; Johnson, Karen; Duara, Shahnaz; Everett-Thomas, Ruth; Watterberg, Kristi L.; Ohls, Robin K.; Rohr, Julie; Lacy, Conra Backstrom; Phelps, Dale L.; Laroia, Nirupama; Markowitz, Gary D; Reubens, Linda J.; Burnell, Erica; Sánchez, Pablo J.; Rosenfeld, Charles R.; Salhab, Walid A.; Allen, James; Grau, Laura; Guzman, Alicia; Hensley, Gaynelle; Lepps, Melissa H.; Martin, Mélissa; Miller, Nancy A.; Solis, Araceli; Vasil, Diana M.; Wilder, Kerry; Kennedy, Kathleen A.; Tyson, Jon E.; Morris, Brenda H.; Harris, Beverly Foley; Lis, Anna E.; Martin, Sarah K.; McDavid, Georgia E.; Tate, Patti L. Pierce; Wright, Sharon L.; Yoder, Bradley A.; Faix, Roger G.; Burnett, Jill; Jensen, Jennifer J.; Osborne, Karen A.; Spencer, Cynthia; Weaver-Lewis, Kimberlee; O’Shea, T. Michael; Peters, Nancy; Shankaran, Seetha; Sood, Beena G.; Bara, Rebecca; Billian, Elizabeth; Johnson, Mary E.; Ehrenkranz, Richard A.; Narendran, Vivek; Bhandari, Vineet; Jacobs, Harris C.; Cervone, Pat; Gettner, Patricia; Konstantino, Monica; Poulsen, JoAnn; Taft, Janet

doi:10.1016/j.jpeds.2017.01.057

Cited by 51 publications

(51 citation statements)

References 36 publications

(49 reference statements)

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“…[4] Considering that the revised algorithm only affected readings between 87–91%, there may be modifying factors that place a subset of ELGANs at increased risk of mortality, even when subjected to only mild hypoxemia (SpO 2 85–89%); for example, post hoc analyses of SUPPORT found that SGA but not AGA infants in the lower SpO 2 group were at increased risk of mortality. [19, 20] This concept needs to be further explored in the complete NeOProM dataset.…”

Section: Neoprom Results: Secondary Outcomes Raise Concernsmentioning

confidence: 99%

Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest

Cummings

Lakshminrusimha

2017

Current Opinion in Pediatrics

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Purpose of review A collaboration of comparative effectiveness research trials of pulse oximeter saturation (SpO2) targeting in extremely low gestational age neonates (ELGANs) have begun to report their aggregate results. We will examine the results of those trials, collectively referred to as the Neonatal Oxygenation Prospective Meta-analysis, or NeOProM. We will also discuss the uncertainties that remain and the clinical challenges that lie ahead. Recent findings The primary outcome from NeOProM was a composite of death or disability at 18–24 months corrected age. Earlier this year, the last of these reports was published. Although there were no differences in the primary outcome overall, analyses of secondary outcomes and data subsets following a pulse oximeter revision show significant treatment differences between targeting a lower compared to a higher SpO2. Summary NeOProM represents the largest collaborative clinical research study of SpO2 targets in ELGANs. While aggregate results give us some insight into the feasibility and efficacy of SpO2 targeting in this population, many questions remain. A patient-level analysis, tracking individual outcomes based on actual SpO2 experienced, may shed some light on these questions. However, finding a single optimal SpO2 range seems unlikely.

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Section: Neoprom Results: Secondary Outcomes Raise Concernsmentioning

confidence: 99%

Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest

Cummings

Lakshminrusimha

2017

Current Opinion in Pediatrics

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“…Appropriate for gestational GA infants had a mortality of 16.4% with no differences between both oxygen saturation target groups. By contrast, SGA children had a significantly higher risk of mortality (38.5%), which was more than 2-fold increased in the lower (56.1%) compared with the higher (25.5%) target group [24, 25]. However, in the Cochrane review, a similar analysis was not performed [19].…”

Section: Introductionmentioning

confidence: 99%

“…SGA infants with saturations ≤92% the first 3 days of life had a substantially lower survival than the other 3 groups at the age of 13 weeks (54 vs. 83–91%) [25]. …”

Section: Introductionmentioning

confidence: 99%

Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits

Saugstad¹

2018

Neonatology

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Background: For 70 years, there has been a search for the optimal oxygenation of premature infants. In spite of the lack of evidence, guidelines have successively reduced oxygenation targets during these years. Objectives: (1) To present a summary of previously published meta-analyses of 5 randomized studies (NeOProM) which tested a low (85–89%) versus a high (91–95%) oxygen saturation target the first weeks after birth on outcome of immature newborn infants. (2) To present international recommendations for oxygenation the first weeks after birth. Methods: Data were retrieved from meta-analyses and reviews of these studies. Results: Mortality and necrotizing enterocolitis (NEC) are significantly higher in patients with a low saturation target (relative risk, RR 1.16 and 1.24, respectively), while severe retinopathy of prematurity (ROP) is reduced (RR 0.74), fortunately without a change in the rate of blindness. Severe intraventricular hemorrhage, patent ductus arteriosus, and bronchopulmonary dysplasia (defined physiologically) were not significantly affected by the oxygen targets in the range of these studies. Based on these data, it is recommended that SpO₂ targets from birth to 36 weeks postconceptional age for infants < 28 weeks gestational age (GA) should be between 90 and 94% (with alarm limits of 89 and 95%), respectively. It is recommended to keep infants small for GA well oxygenated within the suggested targets avoiding fluctuations. Conclusions: The ideal oxygen saturation targets for infants < 28 weeks GA are not known. Mortality, ROP, and NEC seem to be particularly oxygen-sensitive outcome variables. The optimal oxygen saturation for premature infants > 28 weeks GA has not been carefully studied.

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“…The findings of this study are relevant based on the recently reported post hoc analyses of large cohorts of extremely preterm infants enrolled in the Canadian Oxygen Trial and the SUPPORT trial, which showed a significant correlation between prolonged HE and late death or disability, cognitive or language delay, motor impairment, and severe ROP [3,21]. …”

Section: Discussionmentioning

confidence: 95%

Hypoxemia Episodes during Day and Night and Their Impact on Oxygen Saturation Targeting in Mechanically Ventilated Preterm Infants

et al. 2017

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Background: Hypoxemia episodes (HE) occur frequently in ventilated preterm infants and hinder the achievement of arterial oxygen saturation (SpO₂) targets. These episodes may increase the risk for retinopathy of prematurity and neurodevelopmental disability. There are no data on the variation in HE and SpO₂ targeting between day and night. Objective: The aim of this study was to evaluate the difference between day and night on the frequency and severity of HE and achievement of SpO₂ targets. Methods: Twenty-four mechanically ventilated preterm infants with ≥4 episodes of SpO₂ <75% over an 8-h period were enrolled. The fraction of inspired oxygen (FiO₂), SpO₂, and ventilator parameters were recorded over 24 h. Data from the day (9 a.m. to 5 p.m.) were compared to the night (9 p.m. to 5 a.m.) for the frequency of HE and proportion of time within and outside the target SpO₂ range (90-95%). Results: The frequency of severe HE (SpO₂ <75, ≥20 s) and prolonged severe HE (SpO₂ <75, ≥60 s) was lower during the night compared to the day (1.6 ± 1.0 vs. 2.4 ± 1.3 episodes/h, p = 0.008, and 0.53 ± 0.35 vs. 0.90 ± 0.54 episodes/h, p = 0.018). There was no difference in mean episode duration. The frequency and duration of mild HE (SpO₂ <85, ≥20 s) were lower during the night compared to the day (5.9 ± 2.7 vs. 7.1 ± 2.5 episodes/h, p = 0.003, and 72 ± 15 vs. 87 ± 25 s, p = 0.01, respectively). The proportion of time in severe hypoxemia (SpO₂ <75%) was smaller, whereas time in hyperoxemia (SpO₂ >95%) was greater, during the night compared to the day. The mean FiO₂ did not differ between day and night. Conclusion: In this group of infants with frequent HE, nighttime was associated with fewer episodes when compared to daytime. This is likely due to less handling and sensory stimulation during the night. The increase in time spent with hyperoxemia during the night is likely to be due to more tolerance of high SpO₂ with less proactive weaning of FiO₂.

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Patterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort

Cited by 51 publications

References 36 publications

Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest

Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest

Oxygenation of the Immature Infant: A Commentary and Recommendations for Oxygen Saturation Targets and Alarm Limits

Hypoxemia Episodes during Day and Night and Their Impact on Oxygen Saturation Targeting in Mechanically Ventilated Preterm Infants

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