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

• Published in: The Journal of pediatrics Vol. 186; pp. 49 - 56.e1
• Main Authors: Di Fiore, Juliann M., BSEE, Martin, Richard J., MD, Li, Hong, MS, Morris, Nathan, PhD, Carlo, Waldemar A., MD, Finer, Neil, MD, Walsh, Michele, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2017
• Subjects: Cohort Studies; Continuous Positive Airway Pressure; Female; Humans; hypoxia; Hypoxia - metabolism; Hypoxia - mortality; Hypoxia - therapy; Infant, Extremely Premature; Infant, Newborn; Infant, Premature, Diseases - metabolism; Infant, Premature, Diseases - mortality; Infant, Premature, Diseases - therapy; Infant, Small for Gestational Age; intermittent hypoxemia; Male; Oxygen Inhalation Therapy; oxygen saturation; Pediatrics; Pulmonary Surfactants - therapeutic use; small for gestational age; supplemental oxygen; Survival Rate; hypoxia; small for gestational age; Surfactant Positive Pressure and Oxygen Trial; COT; oxygen saturation; HR; SGA; Hazard ratio; SUPPORT; intermittent hypoxemia; Appropriate for gestational age; supplemental oxygen; AGA; Canadian Oxygen Trial
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2017.01.057

Objective To characterize actual achieved patterns of oxygenation in infants born appropriate vs small for gestational age (SGA) randomized to a lower (85-89%) vs higher (91%-95%) oxygen saturation target in the Surfactant Positive Pressure and Oxygen Trial. To determine the association between achieved oxygen saturation levels and survival in infants born appropriate vs SGA enrolled in the Surfactant Positive Pressure and Oxygen Trial. Study design Median oxygen saturation and intermittent hypoxemia events (<80%, 20 seconds-5  minutes) were documented in 1054 infants of 240/7 -276/7  weeks of gestation while receiving supplemental oxygen during the first 3 days of life. Results Lower target infants who were small for gestational age had the lowest oxygen saturation and highest incidence of intermittent hypoxemia during the first 3 days of life. The lowest quartile of oxygen saturation (≤92%) during the first 3 days of life was associated with lower 90-day survival for both infants born appropriate and SGA. An increased incidence of intermittent hypoxemia events during the first 3 days of life was associated with lower 90-day survival only in infants born SGA. Conclusion Lower achieved oxygen saturation during the first 3 days of life was associated with lower 90-day survival in extremely preterm infants. Infants born SGA had enhanced vulnerability to lower oxygen saturation targets as evidenced by lower achieved oxygen saturation and an association between increased intermittent hypoxemia events and lower survival. Trial registration ClinicalTrials.gov : NCT00233324.