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Oxygen saturation and outcomes in preterm infants
Stenson, Ben J. Tarnow-Mordi, William Darlow, Brian A. Simes, John Juszczak, Edmund Askie, Lisa Battin, Malcolm Bowler, Ursula Broadbent, Roland Cairns, Pamela
Stenson, Ben J.
Tarnow-Mordi, William
Darlow, Brian A.
Simes, John
Juszczak, Edmund
Askie, Lisa
Battin, Malcolm
Bowler, Ursula
Broadbent, Roland
Cairns, Pamela
Author
Stenson, Ben J.
Tarnow-Mordi, William
Darlow, Brian A.
Simes, John
Juszczak, Edmund
Askie, Lisa
Battin, Malcolm
Bowler, Ursula
Broadbent, Roland
Cairns, Pamela
Davis, Peter
Deshpande, Sanjeev
Donoghoe, Mark
Doyle, Lex
Fleck, Brian W.
Ghadge, Alpana
Hague, Wendy
Halliday, Henry L.
Hewson, Michael
King, Andrew
Kirby, Adrienne
Marlow, Neil
Meyer, Michael
Morley, Colin
Simmer, Karen
Tin, Win
Wardle, Stephen
Brocklehurst, Peter
Tarnow-Mordi, William
Darlow, Brian A.
Simes, John
Juszczak, Edmund
Askie, Lisa
Battin, Malcolm
Bowler, Ursula
Broadbent, Roland
Cairns, Pamela
Davis, Peter
Deshpande, Sanjeev
Donoghoe, Mark
Doyle, Lex
Fleck, Brian W.
Ghadge, Alpana
Hague, Wendy
Halliday, Henry L.
Hewson, Michael
King, Andrew
Kirby, Adrienne
Marlow, Neil
Meyer, Michael
Morley, Colin
Simmer, Karen
Tin, Win
Wardle, Stephen
Brocklehurst, Peter
Abstract
Background The clinically appropriate range for oxygen saturation in preterm infants is unknown. Previous studies have shown that infants had reduced rates of retinopathy of prematurity when lower targets of oxygen saturation were used. Methods In three international randomized, controlled trials, we evaluated the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks’ gestation. Halfway through the trials, the oximeter-calibration algorithm was revised. Recruitment was stopped early when an interim analysis showed an increased rate of death at 36 weeks in the group with a lower oxygen saturation. We analyzed pooled data from patients and now report hospital-discharge outcomes. Results A total of 2448 infants were recruited. Among the 1187 infants whose treatment used the revised oximeter-calibration algorithm, the rate of death was significantly higher in the lower-target group than in the higher-target group (23.1% vs. 15.9%; relative risk in the lower-target group, 1.45; 95% confidence interval [CI], 1.15 to 1.84; P=0.002). There was heterogeneity for mortality between the original algorithm and the revised algorithm (P=0.006) but not for other outcomes. In all 2448 infants, those in the lower-target group for oxygen saturation had a reduced rate of retinopathy of prematurity (10.6% vs. 13.5%; relative risk, 0.79; 95% CI, 0.63 to 1.00; P=0.045) and an increased rate of necrotizing enterocolitis (10.4% vs. 8.0%; relative risk, 1.31; 95% CI, 1.02 to 1.68; P=0.04). There were no significant betweengroup differences in rates of other outcomes or adverse events. Conclusions Targeting an oxygen saturation below 90% with the use of current oximeters in extremely preterm infants was associated with an increased risk of death. (Funded by the Australian National Health and Medical Research Council and others; BOOST II Current Controlled Trials number, ISRCTN00842661, and Australian New Zealand Clinical Trials Registry numbers, ACTRN12605000055606 and ACTRN12605000253606.)
Keywords
Date
2013
Type
Journal article
Journal
New England Journal of Medicine
Book
Volume
368
Issue
22
Page Range
2094-2104
Article Number
ACU Department
Non-faculty
Collections
Relation URI
Source URL
Event URL
Open Access Status
License
File Access
Controlled