Featured Research

from universities, journals, and other organizations

Effect of different oxygen saturation levels on death or disability in extremely preterm infants

Date:
May 5, 2013
Source:
American Medical Association (AMA)
Summary:
In a randomized trial performed to help resolve the uncertainty about the optimal oxygen saturation therapy in extremely preterm infants, researchers found that targeting saturations of 85 percent to 89 percent compared with 91 percent to 95 percent had no significant effect on the rate of death or disability at 18 months.

In a randomized trial performed to help resolve the uncertainty about the optimal oxygen saturation therapy in extremely preterm infants, researchers found that targeting saturations of 85 percent to 89 percent compared with 91 percent to 95 percent had no significant effect on the rate of death or disability at 18 months, according to a study published by JAMA. The study is being released early online to coincide with its presentation at the Pediatric Academic Societies annual meeting.

"Extremely preterm infants are monitored with pulse oximeters for several weeks after birth because they may require supplemental oxygen intermittently or continuously. The goal of oxygen therapy is to deliver sufficient oxygen to the tissues while minimizing oxygen toxicity and oxidative stress. It remains uncertain what values of arterial oxygen saturations achieve this balance in immature infants, who are especially vulnerable to the harmful effects of oxygen," according to background information in the article.

Barbara Schmidt, M.D., M.Sc., of the Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, and colleagues conducted a study to compare the effects of targeting lower or higher arterial oxygen saturations in extremely preterm infants on the rate of death or disability. The randomized trial, conducted in 25 hospitals in Canada, the United States, Argentina, Finland, Germany, and Israel, included 1,201 infants with gestational ages of 23 weeks 0 days through 27 weeks 6 days, who were enrolled within 24 hours after birth between December 2006 and August 2010. Follow-up assessments began in October 2008 and ended in August 2012.

Study participants were monitored until postmenstrual ages (the time elapsed between the first day of the mother's last menstrual period and birth [gestational age] plus the time elapsed after birth [chronological age]) of 36 to 40 weeks with pulse oximeters that displayed saturations of either 3 percent above or below the true values. Caregivers adjusted the concentration of oxygen to achieve saturations between 88 percent and 92 percent, which produced 2 treatment groups with true target saturations of 85 percent to 89 percent (n=602) or 91 percent to 95 percent (n=599). Alarms were triggered when displayed saturations decreased to 86 percent or increased to 94 percent. The primary outcome was a composite of death, gross motor disability, cognitive or language delay, severe hearing loss, or bilateral blindness at a corrected age of 18 months. Secondary outcomes included retinopathy of prematurity and brain injury.

The researchers found that targeting lower compared with higher oxygen saturations had no significant effect on the rate of death or disability at 18 months. "Of the 578 infants with data for this outcome who were assigned to the lower target range, 298 (51.6 percent) died or survived with disability compared with 283 of the 569 infants (49.7 percent) assigned to the higher target range," the authors write. "Of the 585 infants with known vital status at 18 months in the lower saturation target group, 97 (16.6 percent) had died compared with 88 of 577 (15.3 percent) in the higher saturation target group."

Targeting lower compared with higher saturations reduced the average postmenstrual age at last use of oxygen therapy, but had no significant effect on any other outcomes, including the rate of severe retinopathy of prematurity.

"Clinicians who try to translate the disparate results of the recent oxygen saturation targeting trials into their practice may find it prudent to target saturations between 85 percent and 95 percent while strictly enforcing alarm limits of 85 percent at all times, and of 95 percent during times of oxygen therapy. Our findings do not support recommendations that targeting saturations in the upper 80 percent range should be avoided. Because it is very difficult to maintain infants in a tight saturation target range, such recommendations may lead to increased tolerance of saturations above 95 percent and an increased risk of severe retinopathy. Although no longer a major cause of bilateral blindness, severe retinopathy remains a marker of serious childhood disabilities," the authors conclude.

Editorial: Oxygenation Targets and Outcomes in Premature Infants

In an accompanying editorial, Eduardo Bancalari, M.D., and Nelson Claure, M.Sc., Ph.D., of the University of Miami Miller School of Medicine, comment on the findings of this and other studies that have examined this issue.

"Oxygen therapy continues to present neonatal clinicians with a difficult conundrum where efforts to reduce complications associated with hyperoxemia in premature infants may affect their survival. How the results of these trials should be translated into clinical practice is still controversial. If the long-term outcomes are not affected by the different saturation targets, should the shorter-term outcomes of death, severe retinopathy of prematurity, and bronchopulmonary dysplasia be used to formulate a recommendation? After all, no other outcome is as important as survival. Until the remaining questions raised by these studies are answered by the combined meta-analysis or new evidence becomes available, minimizing extreme oxygenation levels by targeting saturations between 90 and 95 percent appears to be a reasonable approach."


Story Source:

The above story is based on materials provided by American Medical Association (AMA). Note: Materials may be edited for content and length.


Journal References:

  1. Eduardo Bancalari, Nelson Claure. Oxygenation Targets and Outcomes in Premature Infants. JAMA, 2013 DOI: 10.1001/jama.2013.5831
  2. Barbara Schmidt, Robin K. Whyte, Elizabeth V. Asztalos, Diane Moddemann, Christian Poets, Yacov Rabi, Alfonso Solimano, Robin S. Roberts for the Canadian Oxygen Trial (COT) Group. Effects of Targeting Higher vs Lower Arterial Oxygen Saturations on Death or Disability in Extremely Preterm Infants: A Randomized Clinical Trial. JAMA, 2013 DOI: 10.1001/jama.2013.5555

Cite This Page:

American Medical Association (AMA). "Effect of different oxygen saturation levels on death or disability in extremely preterm infants." ScienceDaily. ScienceDaily, 5 May 2013. <www.sciencedaily.com/releases/2013/05/130505145813.htm>.
American Medical Association (AMA). (2013, May 5). Effect of different oxygen saturation levels on death or disability in extremely preterm infants. ScienceDaily. Retrieved July 28, 2014 from www.sciencedaily.com/releases/2013/05/130505145813.htm
American Medical Association (AMA). "Effect of different oxygen saturation levels on death or disability in extremely preterm infants." ScienceDaily. www.sciencedaily.com/releases/2013/05/130505145813.htm (accessed July 28, 2014).

Share This




More Health & Medicine News

Monday, July 28, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Trees Could Save More Than 850 Lives Each Year

Trees Could Save More Than 850 Lives Each Year

Newsy (July 27, 2014) A national study conducted by the USDA Forest Service found that trees collectively save more than 850 lives on an annual basis. Video provided by Newsy
Powered by NewsLook.com
Google's Next Frontier: The Human Body

Google's Next Frontier: The Human Body

Newsy (July 27, 2014) Google is collecting genetic and molecular information to paint a picture of the perfectly healthy human. Video provided by Newsy
Powered by NewsLook.com
What's To Blame For Worst Ebola Outbreak In History?

What's To Blame For Worst Ebola Outbreak In History?

Newsy (July 27, 2014) A U.S. doctor has tested positive for the deadly Ebola virus, as the worst-ever outbreak continues to grow. Video provided by Newsy
Powered by NewsLook.com
Losing Sleep Leaves You Vulnerable To 'False Memories'

Losing Sleep Leaves You Vulnerable To 'False Memories'

Newsy (July 27, 2014) A new study shows sleep deprivation can make it harder for people to remember specific details of an event. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins