Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality
BackgroundRandomized controlled trials have indicated reduced mortality rates in very preterm infants assigned to high compared to low oxygen saturation (SpO2) target levels, accompanied by higher rates of retinopathy of prematurity and bronchopulmonary dysplasia. However, the benefit-to-harm ratio...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2023.1235877/full |
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| author | Nina Willgerodt Christoph Bührer Rainer Rossi Thomas Kühn Mario Rüdiger Stefan Avenarius Ralf Böttger Dirk M. Olbertz Hans Proquitte Hans-Jörg Bittrich Roland Haase Roland Haase Matthias Fröhlich Sybille Höhne Ulrich H. Thome |
| author_facet | Nina Willgerodt Christoph Bührer Rainer Rossi Thomas Kühn Mario Rüdiger Stefan Avenarius Ralf Böttger Dirk M. Olbertz Hans Proquitte Hans-Jörg Bittrich Roland Haase Roland Haase Matthias Fröhlich Sybille Höhne Ulrich H. Thome |
| author_sort | Nina Willgerodt |
| collection | DOAJ |
| description | BackgroundRandomized controlled trials have indicated reduced mortality rates in very preterm infants assigned to high compared to low oxygen saturation (SpO2) target levels, accompanied by higher rates of retinopathy of prematurity and bronchopulmonary dysplasia. However, the benefit-to-harm ratio may depend on the local background mortality risk. We therefore aimed to quantify the risk–benefit ratios of different SpO2 target ranges in 10 tertiary newborn intensive care units (NICUs) in East Germany.MethodsIn a retrospective multicenter study, 1,399 infants born between 2008 and 2012 at a gestational age between 24 0/7 and 27 6/7 weeks and with a birthweight below 1,250 g were grouped according to the hospital's target SpO2 range [high oxygen saturation group (HOSG) above 90%], low oxygen saturation group (LOSG) below 90%] and the compliance of units with their target SpO2 range. The association between neonatal morbidities, neurodevelopmental outcomes, selected treatment strategies, and target SpO2 ranges was calculated using chi-squared and Mann Whitney U tests.ResultsNine of the ten participating NICUs met their SpO2 target ranges. Five units were considered as HOSG, and five units were considered as LOSG. Necrotizing enterocolitis and intraventricular hemorrhage grade ≥ 2 occurred significantly more frequently in the HOSG than in the LOSG (8.4% vs. 5.1%, p = 0.02; and 26.6% vs. 17.7%, p < 0.001). No significant differences in the mortality rate and the rate of retinopathy of prematurity were found.ConclusionIn our patient population, a lower SpO2 target range was not associated with increased safety risks in extremely preterm infants. We cannot be sure that our outcome differences are associated with differences in oxygen saturations due to the retrospective study design and the differences in site practices. |
| first_indexed | 2024-03-11T16:04:10Z |
| format | Article |
| id | doaj.art-88a22674c188434093f258f9d3d15ae3 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-03-11T16:04:10Z |
| publishDate | 2023-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-88a22674c188434093f258f9d3d15ae32023-10-25T06:11:44ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602023-10-011110.3389/fped.2023.12358771235877Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortalityNina Willgerodt0Christoph Bührer1Rainer Rossi2Thomas Kühn3Mario Rüdiger4Stefan Avenarius5Ralf Böttger6Dirk M. Olbertz7Hans Proquitte8Hans-Jörg Bittrich9Roland Haase10Roland Haase11Matthias Fröhlich12Sybille Höhne13Ulrich H. Thome14Division of Neonatology, University Hospital for Children, Leipzig, GermanyDepartment of Neonatology, Charité—Universitätsmedizin Berlin, Berlin, GermanyDivision of Neonatology, Vivantes Hospital Neukölln, Berlin, GermanyDivision of Neonatology, Vivantes Hospital Neukölln, Berlin, GermanyDivision of Neonatology and Pediatric Intensive Care Medicine, Klinik für Kinderheilkunde, Medical Faculty, TU Dresden, Dresden, GermanyDivision of Neonatology, University Hospital for Children, Magdeburg, GermanyDivision of Neonatology, University Hospital for Children, Magdeburg, GermanyDivision of Neonatology, Hospital Südstadt, Rostock, GermanyDivision of Neonatology, University Hospital for Children, Jena, GermanyDivision of Neonatology, Helios Hospital, Erfurt, GermanyDivision of Neonatology, University Hospital for Children, Halle (Saale), Germany0Division of Neonatology, St. Elisabeth and St. Barbara Hospital, Halle (Saale), GermanyDepartment of Neonatology, Charité—Universitätsmedizin Berlin, Berlin, Germany0Division of Neonatology, St. Elisabeth and St. Barbara Hospital, Halle (Saale), GermanyDivision of Neonatology, University Hospital for Children, Leipzig, GermanyBackgroundRandomized controlled trials have indicated reduced mortality rates in very preterm infants assigned to high compared to low oxygen saturation (SpO2) target levels, accompanied by higher rates of retinopathy of prematurity and bronchopulmonary dysplasia. However, the benefit-to-harm ratio may depend on the local background mortality risk. We therefore aimed to quantify the risk–benefit ratios of different SpO2 target ranges in 10 tertiary newborn intensive care units (NICUs) in East Germany.MethodsIn a retrospective multicenter study, 1,399 infants born between 2008 and 2012 at a gestational age between 24 0/7 and 27 6/7 weeks and with a birthweight below 1,250 g were grouped according to the hospital's target SpO2 range [high oxygen saturation group (HOSG) above 90%], low oxygen saturation group (LOSG) below 90%] and the compliance of units with their target SpO2 range. The association between neonatal morbidities, neurodevelopmental outcomes, selected treatment strategies, and target SpO2 ranges was calculated using chi-squared and Mann Whitney U tests.ResultsNine of the ten participating NICUs met their SpO2 target ranges. Five units were considered as HOSG, and five units were considered as LOSG. Necrotizing enterocolitis and intraventricular hemorrhage grade ≥ 2 occurred significantly more frequently in the HOSG than in the LOSG (8.4% vs. 5.1%, p = 0.02; and 26.6% vs. 17.7%, p < 0.001). No significant differences in the mortality rate and the rate of retinopathy of prematurity were found.ConclusionIn our patient population, a lower SpO2 target range was not associated with increased safety risks in extremely preterm infants. We cannot be sure that our outcome differences are associated with differences in oxygen saturations due to the retrospective study design and the differences in site practices.https://www.frontiersin.org/articles/10.3389/fped.2023.1235877/fullpreterm infantoxygen saturationoxygen dilemmamortalitybronchopulmonary dysplasiaretinopathy of prematurity |
| spellingShingle | Nina Willgerodt Christoph Bührer Rainer Rossi Thomas Kühn Mario Rüdiger Stefan Avenarius Ralf Böttger Dirk M. Olbertz Hans Proquitte Hans-Jörg Bittrich Roland Haase Roland Haase Matthias Fröhlich Sybille Höhne Ulrich H. Thome Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality Frontiers in Pediatrics preterm infant oxygen saturation oxygen dilemma mortality bronchopulmonary dysplasia retinopathy of prematurity |
| title | Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality |
| title_full | Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality |
| title_fullStr | Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality |
| title_full_unstemmed | Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality |
| title_short | Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality |
| title_sort | similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality |
| topic | preterm infant oxygen saturation oxygen dilemma mortality bronchopulmonary dysplasia retinopathy of prematurity |
| url | https://www.frontiersin.org/articles/10.3389/fped.2023.1235877/full |
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