Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration

Askie, Lisa; Darlow, Brian A; Finer, Neil N.; Schmidt, Barbara; Stenson, Ben J; Tarnow‐Mordi, William; Davis, Peter G; Carlo, Waldemar A.; Brocklehurst, Peter; Davies, Lucy; Das, Abhik; Rich, Wade; Gantz, Marie G.; Roberts, Robin S.; Whyte, Robin; Costantini, Lorrie; Poets, Christian F.; Asztalos, Elizabeth; Battin, Malcolm; Halliday, Henry L.; Marlow, Neil; Tin, Win; King, Andrew; Juszczak, Edmund; Morley, C J; Doyle, Lex W.; Gebski, Val; Hunter, Kylie E; Simes, R. J.

doi:10.1001/jama.2018.5725

Cited by 336 publications

(193 citation statements)

References 41 publications

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“…In the last 3 years, little has changed in terms of refining previous recommendations for oxygen saturation targeting based on data from the NeOProm collaboration [83]. Targeting lower saturations (85–89 vs. 91–95%) reduces risk of severe retinopathy of prematurity (ROP) but at expense of increasing mortality (relative risk [RR] 1.17; 95% confidence interval [CI] 1.04–1.31) and NEC.…”

Section: Oxygen Supplementation Beyond Stabilisationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Oxygen Supplementation Beyond Stabilisationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…The role of oxygen toxicity in the development of BPD has been shown in both experimental models as well as in clinical trials [22, 23]. …”

Section: Changes In the Pathogenesis Of Bpdmentioning

confidence: 99%

Bronchopulmonary Dysplasia: 50 Years after the Original Description

2019

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Bronchopulmonary dysplasia (BPD) is one of the few diseases in neonatal medicine that has continued to evolve since its first description about 50 years ago. Over these years, advancements in neonatal medicine such as antenatal steroids and exogenous surfactant therapy have significantly reduced neonatal mortality and lowered the limits of viability for preterm infants. Although the incidence of BPD continues to be high, especially in extremely low birth weight infants, the clinical picture has evolved into a milder disease with low mortality or significant morbidities. This new BPD is the result of complex interactions between altered alveolar and vascular development, injury by ante- and postnatal pathogenic factors, and reparative processes in the lung. There has been significant progress in our understanding of risk factors for BPD, but challenges persist in its definition, and in finding effective preventive strategies. There are promising developments with newer preventive interventions such as mesenchymal stem cells, exosomes, immunomodulators, and growth factors, but they are still in preclinical stage. The future challenges include finding ways to define BPD based on the severity of lung pathology, which can better predict long-term outcomes, development of early predictors of lung disease, and finding innovative and evidence-based preventive and management strategies.

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“…Therefore, the monitoring of supplemental oxygen is very important; in preterm infants it is performed measuring the oxygen pulse saturation (SpO 2 ). Although many studies have been carried out, the debate over whether low (85‐89%) or high (91‐95%) SpO 2 target is better remains open: the low target increases mortality and the risk of necrotizing enterocolitis and the high target increases the risk of ROP . Recently, the American Academy of Pediatrics suggested that a 90‐95% SpO 2 represents a reasonable target in substantial agreement with European guidelines that suggest a 90‐94% SpO 2 target …”

Section: Introductionmentioning

confidence: 97%

Automated control of inspired oxygen (FiO₂) in preterm infants: Literature review

Dani

2019

Pediatric Pulmonology

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The vast majority (95%) of very preterm infants receive oxygen‐therapy monitored by oxygen pulse saturation (SpO2). However, they spend a significant percentage of time out of the SpO2 target with a high risk of severe complications such as bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP). Recently, systems allowing the automated control of inspired oxygen (FiO2) for patient delivery to maintain target SpO2 has been become commercially available. We reviewed literature and individuated sixteen studies on the effectiveness of automated control of FiO2 in preterm infants. These studies demonstrate that automated devices are significantly more effective than manual control in maintaining target SpO2 and in preventing hyperoxia, while they seem to be less effective in preventing hypoxia. The studies were very heterogeneous for design, population size, duration, and device used, and this precludes firm conclusions regarding effectiveness and best setting of these systems. Moreover, none of the studies investigated if automated control of FiO2 can actually improve outcome in preterm infants. We conclude that further large‐scale studies are warranted to assess the actual clinical relevance of these devices and to decide if they should become the standard of care.

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Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration

Cited by 336 publications

References 41 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Bronchopulmonary Dysplasia: 50 Years after the Original Description

Automated control of inspired oxygen (FiO₂) in preterm infants: Literature review

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Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration

Cited by 336 publications

References 41 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Bronchopulmonary Dysplasia: 50 Years after the Original Description

Automated control of inspired oxygen (FiO2) in preterm infants: Literature review

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Product

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Automated control of inspired oxygen (FiO₂) in preterm infants: Literature review