Background Avoiding hyperoxia in very low birth weight infants (VLBW) may contribute to the decrease of severe ROP (Chow et al. Pediatrics 2003;111). However, choosing an O2 saturation (SpO2) target that avoids hyperoxia may be associated with detrimental long term effects.
Objective To determine the rate and severity of short- and long- term outcome in VLBW treated before and after the implementation of a change in practice aimed at avoiding hyperoxia.
Design/Methods Retrospective analysis of a prospectively collected database of all infants # 1,250 g admitted to two Emory University NICUs from 1/00 through 12/04. A change in practice was instituted in January 2003 with the objective of avoiding hyperoxia in preterm infants. Prior to the change in policy, O2 saturation (SpO2) high alarms were set at 100% and low alarms at 92%. The target SpO2 aimed to avoid hyperoxia was 93 to 85%. Statistical analysis included bivariate analyses and multivariate logistic regression analyzing factors independently associated with SpO2 targets between the two periods.
Results Between 1/00 and 12/04; 502 infants met enrollment criteria and 202 (40%) were born after change in policy. Birth weight (896 6 211 vs 886 6 219; p = 0.715), gestational age (26.9 6 2.3 vs 27.0 6 2.4; p = .850), and survival (82.3% vs 81.2%; p = .416) were similar between higher and lower saturation periods. The risk for any ROP was significantly lower in the infants treated with aim of avoiding hyperoxia (OR = 0.56 [95% CI = 0.37-0.85=]). The need for supplemental oxygen at 36 weeks' corrected age (OR = 0.68 [95% CI = 0.46-0.95]) and the use of steroids for chronic lung disease (OR = 0.53 [95% CI = 0.29-0.93]) were also lower. There was no difference in the risk of necrotizing enterocolitis (OR = 1.03 [95% CI = 0.96-1.1]), intraventricular hemorrhage (IVH) (OR = 1.09 [95% CI = 0.67-1.54]), and periventricular leukomalacia (PVL) (OR = 1.02 [95% CI = 0.43-3.38]). At 18 months corrected age (CA), the infants treated during the avoid hyperoxia period had similar Mental Developmental Index scores (MDI) (80.6 617.5 vs 81.8 6 18.5; p = .793) than those treated before and similar Psychomotor Developmental Index scores (PDI) (85.3 6 16.8 vs 89.2 6 16.8; p = .387). The proportion of infants with a MDI less than 70 (25.7% vs 18.2%; p = .320) and PDI less than 70 (19.1% vs 18.2%; p = .592) was similar between higher and lower saturation periods.
Conclusions The change in practice to avoid hyperoxia was associated with a significant decrease in neonatal morbidity with no evidence of worse neurological short-term outcome (IVH and PVL). Additionally, avoiding hyperoxia is not associated with adverse long-term outcomes at 18 months CA.
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