Effect of the Target Range on Arterial Oxygen Saturation Stability in Extremely Premature Infants

Kurtom W.a· Dormishian A.b,c· Jain D.d· Schott A.b· Aguilar A.C.b· Grieb G.b,c· Bancalari E.b· Claure N.b,c

Author affiliations

aDivision of Neonatology, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
bDivision of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
cDepartment of Biomedical Engineering, College of Engineering, University of Miami, Miami, FL, USA
dDivision of Neonatology, Department of Pediatrics, Pediatrics, Robert W. Johnson School of Medicine Rutgers University, New Brunswick, NJ, USA

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Article / Publication Details

First-Page Preview

Abstract of Clinical Trials

Received: March 25, 2022
Accepted: May 19, 2022
Published online: August 26, 2022

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 2

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

Abstract

Objective: The aim of this study was to compare the effect of targeting arterial oxygen saturation (SpO2) in the high (93–95%) versus the low portion (90–92%) of the recommended range of 90–95% on oxygenation stability in extremely premature infants. Methods: Premature infants of ≤28 weeks of gestational age who received a fraction of inspired oxygen (FiO2) > 0.21 after day 14 were eligible. FiO2 was adjusted by a dedicated investigator to keep SpO2 between 90–92% and 93–95% for 2 h each in random sequence. Episodes of intermittent hypoxemia (IH) were defined as SpO2 <90% for ≥10 s; severe IH episodes were defined as SpO2 <80% for ≥10 s. Hyperoxemia was defined as SpO2 >95% or >98%. Results: Eighteen premature infants were enrolled. Their (mean ± SD) GA was 26 ± 1.5 w. Seven infants were on mechanical ventilation, 4 infants on nasal ventilation, and 7 infants on nasal cannula. They were on a mean FiO2 0.38 ± 0.12 at study entry. Episodes of IH and severe IH were more frequent during the low compared to the high target (36.6 [27.0–41.3] vs. 16.0 [7.8–19.0], p < 0.001; 8.4 ± 9.3 vs. 3.2 ± 4.3, p = 0.002). The proportions of time with SpO2 >95% and >98% were greater with the high target (13.9 ± 11 vs. 34.1 ± 15.4%, p < 0.001; 0.9 [0–5.7] vs. 3.4 [0.5–16.1]%, p = 0.002). Conclusion: In this group of extremely premature infants, targeting SpO2 at the lower portion of the recommended range resulted in more frequent episodes of IH. However, targeting the higher SpO2 range led to more hyperoxemia. This trade-off warrants further investigation.

© 2022 S. Karger AG, Basel

References Carlo WA, Carlo NN, Finer MC, Walsh W, Rich MG, Gantz AR, et al. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med. 2010 May 27;362(21):1959–69. Di Fiore JM, Bloom JN, Orge F, Schutt A, Schluchter M, Cheruvu VK, et al. A higher incidence of intermittent hypoxemic episodes is associated with severe retinopathy of prematurity. J Pediatr. 2010 Jul;157(1):69–73. Di Fiore JM, Kaffashi F, Loparo K, Sattar A, Schluchter M, Foglyano R, et al. The relationship between patterns of intermittent hypoxia and retinopathy of prematurity in preterm infants. Pediatr Res. 2012 Dec;72(6):606–12. Saugstad OD, Aune D. Optimal oxygenation of extremely low birth weight infants: a meta-analysis and systematic review of the oxygen saturation target studies. Neonatology. 2014;105(1):55–63. Poets CF, Roberts RS, Schmidt B, Whyte RK, Asztalos EV, Bader D, et al. Association between intermittent hypoxemia or bradycardia and late death or disability in extremely preterm infants. JAMA. 2015 Aug 11;314(6):595–603. Di Fiore JM, Dylag AM, Honomichl RD, Hibbs AM, Martin RJ, Tatsuoka C, et al. Early inspired oxygen and intermittent hypoxemic events in extremely premature infants are associated with asthma medication use at 2 years of age. J Perinatol. 2019 Feb;39(2):203–11. Raffay TM, Dylag AM, Sattar A, Abu Jawdeh EG, Cao S, Pax BM, et al. Neonatal intermittent hypoxemia events are associated with diagnosis of bronchopulmonary dysplasia at 36 weeks postmenstrual age. Pediatr Res. 2019 Feb;85(3):318–23. Hagadorn JI, Furey AM, Nghiem TH, Schmid CH, Phelps DL, Pillers DA, et al. Achieved versus intended pulse oximeter saturation in infants born less than 28 weeks’ gestation: the AVIOx study. Pediatrics. 2006 Oct;118(4):1574–82. McEvoy C, Durand M, Hewlett V. Episodes of spontaneous desaturations in infants with chronic lung disease at two different levels of oxygenation. Pediatr Pulmonol. 1993 Mar;15(3):140–4. Di Fiore JM, Walsh M, Wrage L, Rich W, Finer N, Carlo WA, et al. Low oxygen saturation target range is associated with increased incidence of intermittent hypoxemia. J Pediatr. 2012 Dec;161(6):1047–52. Askie LM, Henderson-Smart DJ, Irwig L, Simpson JM. Oxygen-saturation targets and outcomes in extremely preterm infants. N Engl J Med. 2003 Sep 4;349(10):959–67. Unger M, Atkins M, Briscoe WA, King TK. Potentiation of pulmonary vasoconstrictor response with repeated intermittent hypoxia. J Appl Physiol Respir Environ Exerc Physiol. 1977 Oct;43(4):662–7. Custer JR, Hales CA. Influence of alveolar oxygen on pulmonary vasoconstriction in newborn lambs versus sheep. Am Rev Respir Dis. 1985 Aug;132(2):326–31. Tay-Uyboco JS, Kwiatkowski K, Cates DB, Kavanagh L, Rigatto H. Hypoxic airway constriction in infants of very low birth weight recovering from moderate to severe bronchopulmonary dysplasia. J Pediatr. 1989 Sep;115(3):456–9. van Kaam AH, Hummler HD, Wilinska M, Swietlinski J, Lal MK, te Pas AB, et al. Automated versus manual oxygen control with different saturation targets and modes of respiratory support in preterm infants. J Pediatr. 2015 Sep;167(3):545–2. Weintraub Z, Alvaro R, Kwiatkowski K, Cates D, Rigatto H, Effects of inhaled oxygen (up to 40%) on periodic breathing and apnea in preterm infants. J Appl Physiol. 1992 Jan;72(1):116–20. Tourneux P, Léké A, Kongolo G, Cardot V, Dégrugilliers L, Chardon K, et al. Relationship between functional residual capacity and oxygen desaturation during short central apneic events during sleep in “late preterm” infants. Pediatr Res. 2008 Aug;64(2):171–6. Bolivar JM, Gerhardt T, Gonzalez A, Hummler H, Claure N, Everett R, et al. Mechanisms for episodes of hypoxemia in preterm infants undergoing mechanical ventilation. J Pediatr. 1995 Nov;127(5):767–73. Dimaguila MA, Di Fiore JM, Martin RJ, Miller MJ. Characteristics of hypoxemic episodes in very low birth weight infants on ventilatory support. J Pediatr. 1997 Apr;130(4):577–83. Esquer C, Claure N, D’Ugard C, Wada Y, Bancalari E. Role of abdominal muscles activity on duration and severity of hypoxemia episodes in mechanically ventilated preterm infants. Neonatology. 2007;92(3):182–6. Esquer C, Claure N, D’Ugard C, Wada Y, Bancalari E. Mechanisms of hypoxemia episodes in spontaneously breathing preterm infants after mechanical ventilation. Neonatology. 2008;94(2):100–4. Schmidt B, Roberts RS, Whyte RK, Asztalos EV, Poets C, Rabi Y, et al. Impact of study oximeter masking algorithm on titration of oxygen therapy in the Canadian oxygen trial. J Pediatr. 2014 Oct;165(4):666–e2. Claure N, D’Ugard C, Bancalari E. Automated adjustment of inspired oxygen in preterm infants with frequent fluctuations in oxygenation: a pilot clinical trial. J Pediatr. 2009 Nov;155(5):640–2. Claure N, Bancalari E, D’Ugard C, Nelin L, Stein M, Ramanathan R, et al. Multicenter crossover study of automated control of inspired oxygen in ventilated preterm infants. Pediatrics. 2011 Jan;127(1):e76–83. Sink DW, Hope SA, Hagadorn JI. Nurse:patient ratio and achievement of oxygen saturation goals in premature infants. Arch Dis Child Fetal Neonatal Ed. 2011 Mar;96(2):F93–8. Article / Publication Details

First-Page Preview

Abstract of Clinical Trials

Received: March 25, 2022
Accepted: May 19, 2022
Published online: August 26, 2022

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 2

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

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