Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis.
Abstract | IMPORTANCE: The optimal oxygen saturation (SpO2) target for extremely preterm infants is unknown. OBJECTIVE: To systematically review evidence evaluating the effect of restricted vs liberal oxygen exposure on morbidity and mortality in extremely preterm infants. DATA SOURCES: MEDLINE, PubMed, CENTRAL, and CINAHL databases from their inception to March 31, 2014, and abstracts submitted to Pediatric Academic Societies from 2000 to 2014. STUDY SELECTION: All published randomized trials evaluating the effect of restricted (SpO2, 85%-89%) vs liberal (SpO2, 91%-95%) oxygen exposure in preterm infants (<28 weeks' gestation at birth). DATA EXTRACTION AND SYNTHESIS: All meta-analyses were performed using Review Manager 5.2. The Cochrane risk-of-bias tool was used to assess study quality. The summary of the findings and the level of confidence in the estimate of effect were assessed using GRADEpro. Treatment effect was analyzed using a random-effects model. MAIN OUTCOMES AND MEASURES: RESULTS: Five trials were included in the final synthesis. These studies had a similar design with a prespecified composite outcome of death/disability at 18 to 24 months corrected for prematurity; however, this outcome has not been reported for 2 of the 5 trials. There was no difference in the outcome of death/disability before 24 months (risk ratio [RR], 1.02 [95% CI, 0.92-1.14]). Mortality before 24 months was not different (RR, 1.13 [95% CI, 0.97-1.33]); however, a significant increase in mortality before hospital discharge was found in the restricted oxygen group (RR, 1.18 [95% CI, 1.03-1.36]). The rates of bronchopulmonary dysplasia, neurodevelopmental outcomes, hearing loss, and retinopathy of prematurity were similar between the 2 groups. Necrotizing enterocolitis occurred more frequently in infants on restricted oxygen (RR, 1.24 [95% CI, 1.05-1.47]). Using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, we found that the quality of evidence for these outcomes was moderate to low. CONCLUSIONS AND RELEVANCE:
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Authors | Veena Manja, Satyan Lakshminrusimha, Deborah J Cook |
Journal | JAMA pediatrics
(JAMA Pediatr)
Vol. 169
Issue 4
Pg. 332-40
(Apr 2015)
ISSN: 2168-6211 [Electronic] United States |
PMID | 25664703
(Publication Type: Journal Article, Meta-Analysis, Research Support, N.I.H., Extramural, Review, Systematic Review)
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Chemical References |
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Topics |
- Bronchopulmonary Dysplasia
(epidemiology)
- Developmental Disabilities
(epidemiology)
- Enterocolitis, Necrotizing
(epidemiology)
- Hearing Loss
(epidemiology)
- Hospital Mortality
- Humans
- Infant
- Infant Mortality
- Infant, Extremely Premature
- Infant, Low Birth Weight
- Infant, Newborn
- Oxygen
(administration & dosage, blood)
- Oxygen Inhalation Therapy
(adverse effects, standards)
- Retinopathy of Prematurity
(epidemiology, etiology)
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