Randomized Controlled Trial of Oxygen Saturation Targets in Very Preterm Infants: Two Year Outcomes

Darlow, Brian A; Marschner, Simone; Donoghoe, Mark; Battin, Malcolm; Broadbent, Roland; Elder, Mark; Hewson, Michael; Meyer, Michael; Ghadge, Alpana; Graham, Patrick; McNeill, Nicolette; Kuschel, Carl A; Tarnow‐Mordi, William

doi:10.1016/j.jpeds.2014.01.017

Cited by 77 publications

(62 citation statements)

References 24 publications

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“…The BOOST II trial was halted because an interim analysis showed that survival at 36 wk PMA was higher with the higher oxygen saturation target (14). However, 2-y outcomes did not show a significant effect on the rate of death or disability (New Zealand Collaborative Group) (25). On the other hand, the Canadian Oxygen Trial did not show an increase in mortality or disability at 18 mo with the lower SpO 2 target of 85-89% compared with 91-95% (15).…”

Section: Discussionmentioning

confidence: 88%

Graded oxygen saturation targets and retinopathy of prematurity in extremely preterm infants

et al. 2016

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Background:We compared the incidence of severe retinopathy of prematurity (ROP) and need for laser treatment before and after implementing graded pulse oximeter oxygen saturation (SpO 2 ) targets in extremely preterm infants. Mortality and other secondary outcomes were compared. Methods: Before 2002, we used 90-94% as the SpO 2 target in infants 24 0/7 -27 6/7 wk gestation and birth weight <1,000 g until 35 6/7 wk postmenstrual age (PMA). We implemented graded SpO 2 targets based on vaso-obliterative and vaso-proliferative phases of ROP in 2002. Group 1 (1995 (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010) after implementation of graded SpO 2 targets based on PMA (83-89% until 32 6/7 wk, 90-94% until 35 6/7 wk and >94% at ≥ 36 wk PMA). results: There were 267 patients in Group 1 and 220 in Group 2. There was no significant difference in birth weight or gestational age. Severe ROP (adjusted OR: 0.18, 95% CI: 0.11, 0.30; P < 0.001) and laser surgery rates (adjusted OR: 0.31, 95% CI: 0.18, 0.52; P < 0.001) decreased significantly in Group 2. There was no difference in mortality (adjusted OR: 0.74, 95% CI: 0.37, 1.49; P = 0.40). conclusion: In this retrospective cohort study, implementation of graded SpO 2 targets decreased severe ROP and need for laser therapy, without increasing mortality.before, and Group 2

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Section: Discussionmentioning

confidence: 88%

Graded oxygen saturation targets and retinopathy of prematurity in extremely preterm infants

et al. 2016

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“…Therefore, to minimize the risk of bias from postrandomization exclusions, alternative measures of cognition and language were prespecified in revised statistical analysis plans before the data were analyzed (Tables S1 through S3 in the Supplementary Appendix, available at NEJM.org). 7,14 If these outcomes remained unknown and the child was not blind or deaf and did not have cerebral palsy, data on the primary outcome were judged as missing.…”

Section: Assessmentsmentioning

confidence: 99%

“…[3][4][5][6][7][8] These trials, known collectively as the Neonatal Oxygen Prospective Meta-analysis (NeOProM) Collaboration, were designed to compare the effects of a lower oxygen-saturation target range (85 to 89%) versus a higher target range (91 to 95%) on a primary outcome of death or major disability at 18 to 24 months, with age corrected for prematurity. 3 Observational data had suggested that targeting an oxygen saturation below 90% was associated with a lower risk of severe retinopathy, with no difference in the rate of cerebral palsy or survival, 9 and that the long-accepted "physiologic" targets of oxygen saturation may be too high.…”

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confidence: 99%

Outcomes of Two Trials of Oxygen-Saturation Targets in Preterm Infants

et al. 2016

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“…No signifi cant differences in a pooled analysis of all 3 trials 47 • Change in oximeter algorithm during the study No signifi cant difference in individual trial analyses 46,48 • Study stopped before complete enrollment N = 2448…”

Section: Randomized Clinical Trials Of Oxygen Targetingmentioning

confidence: 99%

Oxygen Targeting in Extremely Low Birth Weight Infants

Cummings¹,

Polin²,

Newborn³

2016

Pediatrics

112

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The use of supplemental oxygen plays a vital role in the care of the critically ill preterm infant, but the unrestricted use of oxygen can lead to unintended harms, such as chronic lung disease and retinopathy of prematurity. An overly restricted use of supplemental oxygen may have adverse effects as well. Ideally, continuous monitoring of tissue and cellular oxygen delivery would allow clinicians to better titrate the use of supplemental oxygen, but such monitoring is not currently feasible in the clinical setting. The introduction of pulse oximetry has greatly aided the clinician by providing a relatively easy and continuous estimate of arterial oxygen saturation, but pulse oximetry has several practical, technical, and physiologic limitations. Recent randomized clinical trials comparing different pulse oximetry targets have been conducted to better inform the practice of supplemental oxygen use. This clinical report discusses the benefits and limitations of pulse oximetry for assessing oxygenation, summarizes randomized clinical trials of oxygen saturation targeting, and addresses implications for practice.

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Randomized Controlled Trial of Oxygen Saturation Targets in Very Preterm Infants: Two Year Outcomes

Cited by 77 publications

References 24 publications

Graded oxygen saturation targets and retinopathy of prematurity in extremely preterm infants

Graded oxygen saturation targets and retinopathy of prematurity in extremely preterm infants

Outcomes of Two Trials of Oxygen-Saturation Targets in Preterm Infants

Oxygen Targeting in Extremely Low Birth Weight Infants

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