Division of Neonatology, Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.
Neonatology. 2022;119(5):638-643. doi: 10.1159/000525271. Epub 2022 Aug 26.
The aim of this study was to compare the effect of targeting arterial oxygen saturation (SpO2) in the high (93-95%) versus the low portion (90-92%) of the recommended range of 90-95% on oxygenation stability in extremely premature infants.
Premature infants of ≤28 weeks of gestational age who received a fraction of inspired oxygen (FiO2) > 0.21 after day 14 were eligible. FiO2 was adjusted by a dedicated investigator to keep SpO2 between 90-92% and 93-95% for 2 h each in random sequence. Episodes of intermittent hypoxemia (IH) were defined as SpO2 <90% for ≥10 s; severe IH episodes were defined as SpO2 <80% for ≥10 s. Hyperoxemia was defined as SpO2 >95% or >98%.
Eighteen premature infants were enrolled. Their (mean ± SD) GA was 26 ± 1.5 w. Seven infants were on mechanical ventilation, 4 infants on nasal ventilation, and 7 infants on nasal cannula. They were on a mean FiO2 0.38 ± 0.12 at study entry. Episodes of IH and severe IH were more frequent during the low compared to the high target (36.6 [27.0-41.3] vs. 16.0 [7.8-19.0], p < 0.001; 8.4 ± 9.3 vs. 3.2 ± 4.3, p = 0.002). The proportions of time with SpO2 >95% and >98% were greater with the high target (13.9 ± 11 vs. 34.1 ± 15.4%, p < 0.001; 0.9 [0-5.7] vs. 3.4 [0.5-16.1]%, p = 0.002).
In this group of extremely premature infants, targeting SpO2 at the lower portion of the recommended range resulted in more frequent episodes of IH. However, targeting the higher SpO2 range led to more hyperoxemia. This trade-off warrants further investigation.
本研究旨在比较将动脉血氧饱和度（SpO2）目标值设定在推荐范围 90-95%的高（93-95%）部分与低（90-92%）部分对极早产儿氧合稳定性的影响。
纳入胎龄≤28 周、出生 14 天后接受吸入氧分数（FiO2）>0.21 的早产儿。由专门的研究人员调整 FiO2，使 SpO2 在随机顺序下每 2 小时分别维持在 90-92%和 93-95%之间。间歇性低氧血症（IH）发作定义为 SpO2<90%持续≥10s；严重 IH 发作定义为 SpO2<80%持续≥10s。高氧血症定义为 SpO2>95%或>98%。
共纳入 18 名早产儿。其（均值±标准差）GA 为 26±1.5 周。7 名婴儿接受机械通气，4 名婴儿接受鼻通气，7 名婴儿接受鼻导管吸氧。研究开始时，他们的平均 FiO2 为 0.38±0.12。与高目标相比，低目标时 IH 和严重 IH 发作更频繁（36.6[27.0-41.3]vs.16.0[7.8-19.0]，p<0.001；8.4±9.3vs.3.2±4.3，p=0.002）。高目标时 SpO2>95%和>98%的时间比例更大（13.9±11vs.34.1±15.4%，p<0.001；0.9[0-5.7]vs.3.4[0.5-16.1]%，p=0.002）。
在这组极早产儿中，将 SpO2 目标值设定在推荐范围的较低部分会导致更频繁的 IH 发作。然而，将 SpO2 目标值设定在较高范围会导致更多的高氧血症。这种权衡需要进一步研究。
