Effect of oxygen saturation targets on the incidence of bronchopulmonary dysplasia and duration of respiratory supports in extremely preterm infants

Youstina Hanna; Corinne Laliberté; Nadya Ben Fadel; Brigitte Lemyre; Bernard Thébaud; Nicholas Barrowman; Vid Bijelic; Lynda Hoey; Sherri L Katz

doi:10.1093/pch/pxz058

Effect of oxygen saturation targets on the incidence of bronchopulmonary dysplasia and duration of respiratory supports in extremely preterm infants

Paediatr Child Health. 2020 Apr;25(3):173-179. doi: 10.1093/pch/pxz058. Epub 2019 May 31.

Authors

Youstina Hanna¹, Corinne Laliberté¹, Nadya Ben Fadel^{1

2}, Brigitte Lemyre^{1

2}, Bernard Thébaud^{1

2}, Nicholas Barrowman³, Vid Bijelic³, Lynda Hoey³, Sherri L Katz^{1

2

3}

Affiliations

¹ Faculty of Medicine, University of Ottawa, Ottawa, Ontario.
² Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario.
³ Clinical Research Unit, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.

Abstract

Background: Recent clinical practice changes in neonatal care resulted in higher, narrower oxygen saturation target ranges for preterm infants. The effect of targeting higher or lower oxygen saturations on respiratory outcomes of preterm infants and duration of hospitalization has not been extensively reviewed in the context of current care, but could have significant implications.

Methods: A multicentre retrospective cohort of 145 preterm infants was conducted; 105 had lower oxygen saturation targets (88 to 92%), 40 had higher targets (90 to 95%). The primary outcome was bronchopulmonary dysplasia (BPD). Secondary outcomes included duration of invasive/noninvasive respiratory support, oxygen therapy, and hospitalization. The primary outcome was compared using Fisher's exact test. Secondary outcomes were evaluated with survival analysis and Wilcoxon rank sum test.

Results: The difference in incidence of BPD in the lower (N=56, 53.3%) and higher saturation groups (N=14, 35.0%) was not statistically significant (relative risk [RR]=0.66 [0.41, 1.04], P=0.06). The difference in duration of mechanical ventilation in the lower (median 7.8 days, interquartile range [IQR] 3.7 to 15.9) and higher saturation groups (median 4.5, IQR 1.9 to 12.3) approached statistical significance (P=0.05). There were no statistically significant differences in the durations of other respiratory supports or hospital stay between the two groups.

Conclusions: The results of this study approached statistical significance and suggest that higher, narrower oxygen saturation targets may result in a clinically important reduction in BPD incidence and duration of mechanical ventilation. These results require validation in a larger sample to refine optimal targets.

Keywords: Discharge; Neonatology; Oxygen therapy; Prematurity; Ventilation.