Oxygen saturation targeting by pulse oximetry in the extremely low gestational age neonate: a quixotic quest

Abstract

Purpose of review A collaboration of comparative effectiveness research trials of pulse oximeter saturation (SpO2) targeting in extremely low gestational age neonates (ELGANs) have begun to report their aggregate results. We will examine the results of those trials, collectively referred to as the Neonatal Oxygenation Prospective Meta-analysis, or NeOProM. We will also discuss the uncertainties that remain and the clinical challenges that lie ahead. Recent findings The primary outcome from NeOProM was a composite of death or disability at 18–24 months corrected age. Earlier this year, the last of these reports was published. Although there were no differences in the primary outcome overall, analyses of secondary outcomes and data subsets following a pulse oximeter revision show significant treatment differences between targeting a lower compared to a higher SpO2. Summary NeOProM represents the largest collaborative clinical research study of SpO2 targets in ELGANs. While aggregate results give us some insight into the feasibility and efficacy of SpO2 targeting in this population, many questions remain. A patient-level analysis, tracking individual outcomes based on actual SpO2 experienced, may shed some light on these questions. However, finding a single optimal SpO2 range seems unlikely.

Hypoxemic and hyperoxemic likelihood in pulse oximetry ranges: NICU observational study

“…This is consistent with our findings. Others have suggested that a somewhat lower target could be a better balance of outcome risks 10 14 27 28. Our data would support the latter as well, if the clinical goal was to reduce the likelihood of hyperoxemia and accept a marginal increase in the likelihood of hypoxemia.…”

“…Marked changes in outcome of preterm infants have consistently been reported with shifts in related practice guidelines5–7 and in randomised evaluations 8 9. However, identification of an optimum SpO 2 target range has been elusive 10. More recent analyses have suggested that episodic exposure to SpO 2 extremes is more important than selection of the SpO 2 target range 11–14.…”

“…Large studies have shown reasonable agreement between SpO 2 and arterial oxygen saturation (SaO 2 ) within the desired clinical range, but marked bias outside 15–17. Other factors further compound the ability to predict arterial oxygen levels (PaO 2 ) from SpO 2 readings 2 10 18. Two large studies have evaluated the relationship between SpO 2 and PaO 2 in neonates, but reached contrasting conclusions 19 20…”

A review of approaches for analysing obstructive sleep apnoea‐related patterns in pulse oximetry data

“…Assisting the titration of supplemental oxygen treatment in preterm neonates may also be a particularly useful application. Large prospective trials have shown that higher SpO 2 target ranges (SpO 2 = 91–95%) manifest in increased risk of retinopathy, but that lower SpO 2 targets (SpO 2 = 85–90%) manifest in increased risk of death . However, recognizing that even healthy infants have a substantial incidence of short, shallow desaturations, detailed oximetry quantification may allow ‘normal’ ranges to be defined, and thereby facilitate development of sophisticated oxygen targeting strategies …”

Monitorização da oferta do oxigênio suplementar em neonatos: desafios e potências

“…A oxigenoterapia suplementar é uma das intervenções terapêuticas mais utilizada na Unidade de Terapia Intensiva Neonatal. Desse modo, pode-se afirmar que, da mesma forma que a comida, o calor, e a água, também o oxigênio é vital para manter a vida, no entanto, seu excesso pode causar danos (1) .…”