Low oxygen saturation target range is associated with increased incidence of intermittent hypoxemia

Juliann M Di Fiore, Michele Walsh, Lisa Wrage, Wade Rich, Neil Finer, Waldemar A Carlo, Richard J Martin, SUPPORT Study Group of Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Abhik Das, Marie Gantz, Alan H Jobe, Michael S Caplan, Avroy A Fanaroff, Nancy S Newman, Bonnie S Siner, Arlene Zadell, Rosemary D Higgins, Stephanie Wilson Archer, Abhik Das, W Kenneth Poole, Marie G Gantz, Margaret Cunningham, Betty K Hastings, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, James W Pickett 2nd, Dennis Wallace, Kristin M Zaterka-Baxter, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Maynard R Rasmussen, Paul R Wozniak, Kathy Arnell, Renee Bridge, Clarence Demetrio, Juliann M Di Fiore, Michele Walsh, Lisa Wrage, Wade Rich, Neil Finer, Waldemar A Carlo, Richard J Martin, SUPPORT Study Group of Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network, Abhik Das, Marie Gantz, Alan H Jobe, Michael S Caplan, Avroy A Fanaroff, Nancy S Newman, Bonnie S Siner, Arlene Zadell, Rosemary D Higgins, Stephanie Wilson Archer, Abhik Das, W Kenneth Poole, Marie G Gantz, Margaret Cunningham, Betty K Hastings, Jeanette O'Donnell Auman, Carolyn Petrie Huitema, James W Pickett 2nd, Dennis Wallace, Kristin M Zaterka-Baxter, Monica V Collins, Shirley S Cosby, Vivien A Phillips, Maynard R Rasmussen, Paul R Wozniak, Kathy Arnell, Renee Bridge, Clarence Demetrio

Abstract

Objective: To test the hypothesis that preterm infants randomized to a low vs high O(2) saturation target range have a higher incidence of intermittent hypoxemia.

Study design: A subcohort of 115 preterm infants with high resolution pulse oximetry enrolled in the Surfactant, Positive Pressure, and Oxygenation Randomized Trial were randomized to low (85%-89%) or high (91%-95%) O(2) saturation target ranges. Oxygen saturation was monitored until 36 weeks postmenstrual age or until the infant was breathing room air without respiratory support for ≥72 hours.

Results: The low target O(2) saturation group had a higher rate of intermittent hypoxemia (≤80% for ≥10 seconds and ≤3 minutes) prior to 12 days and beyond 57 days of life (P < .05). The duration shortened (P < .0001) and the severity increased (P < .0001) with increasing postnatal age with no differences between target saturation groups. The higher rate of intermittent hypoxemia events in the low target group was associated with a time interval between events of <1 minute.

Conclusion: A low O(2) saturation target was associated with an increased rate of intermittent hypoxemia events that was dependent on postnatal age. The duration and severity of events was comparable between target groups. Further investigation is needed to assess the role of intermittent hypoxemia and their timing on neonatal morbidity.

Copyright © 2012 Mosby, Inc. All rights reserved.

Figures

Figure 1
Figure 1
A raw SaO2 waveform with the duration of the event, denoted by arrows above, and the time interval between events, denoted by arrows below.
Figure 2
Figure 2
A, The model based estimates showed an increase in intermittent hypoxemia events over the first 3 weeks of life in both infant groups followed by a decrease in intermittent hypoxemia events in the high target group compared with a plateau in the low target group. B, The RR of intermittent hypoxemia events (the ratio of the adjusted mean number of intermittent hypoxemia events in the low target group/the adjusted mean number of intermittent hypoxemia events in the high target group, per day) revealed a higher rate of intermittent hypoxemia events from <12 days, and >57 days of age in the low target group (*P < .05). IH, intermittent hypoxemia.
Figure 3
Figure 3
Intermittent hypoxemia event A, duration decreased and B, severity worsened with increasing postnatal age in both the low and high target groups with no differences between groups.

Source: PubMed

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