Elsevier

The Journal of Pediatrics

Volume 186, July 2017, Pages 49-56.e1
The Journal of Pediatrics

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

https://doi.org/10.1016/j.jpeds.2017.01.057Get rights and content

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.

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

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    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).

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