Huizing Maurice Jacob, Hundscheid Tamara Maria, Bartoš František, Villamor Eduardo
Division of Neonatology, MosaKids Children's Hospital, Maastricht University Medical Center (MUMC+), Research Institute for Oncology and Reproduction (GROW), Maastricht University, 6202 AZ Maastricht, The Netherlands.
Department of Psychology, University of Amsterdam, 1001 NK Amsterdam, The Netherlands.
Antioxidants (Basel). 2024 Apr 24;13(5):509. doi: 10.3390/antiox13050509.
Data from the Neonatal Oxygenation Prospective Meta-analysis (NeOProM) indicate that targeting a higher (91-95%) versus lower (85-89%) pulse oximeter saturation (SpO) range may reduce mortality and necrotizing enterocolitis (NEC) and increase retinopathy of prematurity (ROP). Aiming to re-evaluate the strength of this evidence, we conducted a Bayesian reanalysis of the NeOProM data. We used Bayes factors (BFs) to evaluate the likelihood of the data under the combination of models assuming the presence vs. absence of effect, heterogeneity, and moderation by sex. The Bayesian reanalysis showed moderate evidence in favor of no differences between SpO targets (BF = 0.30) in death or major disability, but moderate evidence (BF = 3.60) in favor of a lower mortality in the higher SpO group. Evidence in favor of differences was observed for bronchopulmonary dysplasia (BPD) (BF = 14.44, lower rate with lower SpO), severe NEC (BF = 9.94), and treated ROP (BF = 3.36). The only outcome with moderate evidence in favor of sex differences was BPD. This reanalysis of the NeOProM trials confirmed that exposure to a lower versus higher SpO range is associated with a higher mortality and risk of NEC, but a lower risk of ROP and BPD. The Bayesian approach can help in assessing the strength of evidence supporting clinical decisions.
新生儿氧合前瞻性荟萃分析（NeOProM）的数据表明，将脉搏血氧饱和度（SpO）目标范围设定为较高水平（91-95%）而非较低水平（85-89%），可能会降低死亡率和坏死性小肠结肠炎（NEC）的发生率，并增加早产儿视网膜病变（ROP）的发生率。为了重新评估这一证据的力度，我们对NeOProM数据进行了贝叶斯再分析。我们使用贝叶斯因子（BFs）来评估在假设存在或不存在效应、异质性以及性别调节的模型组合下数据的可能性。贝叶斯再分析显示，在死亡或严重残疾方面，有适度证据支持SpO目标之间无差异（BF = 0.30），但有适度证据（BF = 3.60）支持较高SpO组的死亡率较低。在支气管肺发育不良（BPD）（BF = 14.44，较低SpO时发生率较低）、重度NEC（BF = 9.94）和治疗性ROP（BF = 3.36）方面，观察到了支持差异的证据。唯一有适度证据支持性别差异的结局是BPD。对NeOProM试验的这一再分析证实，暴露于较低而非较高的SpO范围与较高的死亡率和NEC风险相关，但与较低的ROP和BPD风险相关。贝叶斯方法有助于评估支持临床决策的证据力度。
