Original ArticlesPatterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort
Section snippets
Methods
This study included 1316 infants born preterm (240/7-276/7 weeks of gestation) who were enrolled in SUPPORT,1 a randomized trial (ClinicalTrials.gov: NCT00233324) to compare the target ranges of 85%-89% (lower) or 91%-95% (higher) oxygen saturation on the composite outcome of severe retinopathy of prematurity, death before hospital discharge, or both. In the main trial, 654 infants were randomized to the lower target while 662 infants were randomized to the higher target. Of the 654 infants in
Results
Infants were enrolled from February 2005 to February 2009. A lower 90-day survival rate was associated with lower birthweight (P < .0001) and younger gestational age (P < .0001; Table I).
Discussion
Previous data from the SUPPORT multicenter trial randomizing infants to a lower (85%-89%) vs higher (91%-95%) saturation target revealed a higher mortality in the lower oxygen saturation target group. We have found evidence previously of an interaction between infants born SGA and lower oxygen targets associated with increased mortality based on an intention to treat analysis.6 The objective of this analysis was to characterize actual achieved patterns of oxygenation in infants born AGA vs
References (36)
- et al.
A higher incidence of intermittent hypoxemic episodes is associated with severe retinopathy of prematurity
J Pediatr
(2010) - et al.
A United States national reference for fetal growth
Obstet Gynecol
(1996) Pulmonary hypertension and vascular abnormalities in bronchopulmonary dysplasia
- et al.
Characteristics of hypoxemic episodes in very low birth weight infants on ventilatory support
J Pediatr
(1997) - et al.
Episodic neonatal hypoxia evokes executive dysfunction and regionally specific alterations in markers of dopamine signaling
Neuroscience
(2003) - et al.
Automated respiratory support in newborn infants
Semin Fetal Neonatal Med
(2009) - et al.
Target ranges of oxygen saturation in extremely preterm infants
N Engl J Med
(2010) - et al.
Increased 36-week survival with high oxygen saturation target in extremely preterm infants
N Engl J Med
(2011) - et al.
Association between intermittent hypoxemia or bradycardia and late death or disability in extremely preterm infants
JAMA
(2015) - et al.
Low oxygen saturation target range is associated with increased incidence of intermittent hypoxemia
J Pediatr
(2012)
Association of oxygen target and growth status with increased mortality in small for gestational age infants: further analysis of the surfactant, positive pressure and pulse oximetry randomized trial
JAMA Pediatr
The relationship between patterns of intermittent hypoxia and retinopathy of prematurity in preterm infants
Pediatr Res
Oxygen saturation and outcomes in preterm infants
N Engl J Med
Development of ventilatory responsiveness to progressive hypoxia and hypercapnia in low-birth-weight lambs
J Appl Physiol
Effects of intra-uterine growth restriction on the control of breathing and lung development after birth
Clin Exp Pharmacol Physiol
Episodes of spontaneous desaturations in infants with chronic lung disease at two different levels of oxygenation
Pediatr Pulmonol
Mechanism underlying accelerated arterial oxygen desaturation during recurrent apnea
Am J Respir Crit Care Med
Oxygenation targets and outcomes in premature infants
JAMA
Cited by (49)
Ischemia modified albumin as a marker of hypoxia in preterm infants in the first week after birth
2024, Early Human DevelopmentThe relationship between intermittent hypoxemia events and neural outcomes in neonates
2021, Experimental NeurologyAre we over-treating hypoxic spells in preterm infants?
2021, Seminars in Fetal and Neonatal MedicineCitation Excerpt :In rodents, exposure to a single brief [5 min] cycle of hypoxia during the first 24 h after birth, and milder cycles of hypoxia during the first 3–4 weeks of life enhanced long-term spatial learning, memory and structural changes in both the hippocampus and frontal cortex [13,14]. In neonates short or tightly clustered [<1 min apart] IH events were not associated with morbidity, but the risk associated with such patterns may be confounded by other factors, such as intrauterine growth restriction as we have observed [11]. In adults, various therapeutic mild IH paradigms are currently being examined for sleep apnea, systemic hypertension, depression, and neural inflammation [15].
Cardiorespiratory Events in Infants Born Preterm during the Transitional Period
2020, Journal of PediatricsOxygen metabolism and oxygenation of the newborn
2020, Seminars in Fetal and Neonatal Medicine
Supported by The National Institutes of Health (NIH), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Heart, Lung, and Blood Institute (NHLBI), and the National Center for Research Resources, and the National Center for Advancing Translational Sciences (1RO3HD078528-01A1, U10 HD21364, U10 HD21373, U10 HD21385, U10 HD21397, U10 HD27851, U10 HD27853, U10 HD27856, U10 HD27880, U10 HD27871, U10 HD27904, U10 HD34216, U10 HD36790, U10 HD40461, U10 HD40492, U10 HD40498, U10 HD40521, U10 HD40689, U10 HD53089, U10 HD53109, U10 HD53119, and U10 HD53124, M01 RR30, M01 RR32, M01 RR39, M01 RR44, M01 RR54, M01 RR59, M01 RR64, M01 RR70, M01 RR80, MO1 RR125, M01 RR633, M01 RR750, M01 RR997, M01 RR6022, M01 RR7122, M01 RR8084, M01 RR16587, UL1 RR25008, UL1 RR24139, UL1 RR24979, and UL1 RR25744). Participating Neonatal Research Network (NRN) sites collected and transmitted data to RTI International, the data coordinating center (DCC) for the network, which stored, and managed the data for this study. The authors declare no conflicts of interest.
- *
List of additional members of the SUPPORT Study Group is available at www.jpeds.com (Appendix).