Abstract：
BACKGROUND: Optimal oxygen saturation targets remain unknown for extremely preterm infants.
METHODS: Cohort analysis of eligible preterm infants born <29 weeks\' gestation admitted between 2011 and 2018 to centers submitting data to the Canadian Neonatal Network (CNN) database. Site questionnaires to determine saturation targets, alarm settings, and date of change, allowed assignation of centers to intermediate (88-93%) or high (90-95%) saturation targets. A 6-month washout period was applied to sites which switched targets during the study period. Our primary outcome was survival free of major morbidity. Secondary outcomes were death, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity, and evidence of brain injury during admission. Generalized estimating equations were applied to compensate for demographic differences and site practices.
RESULTS: There were 2,739 infants in the high (mean gestational age [GA] 26 ± 1.6 weeks) and 6,813 infants in the intermediate (mean GA 26.2 ± 1.6 weeks) saturation target group. Survival without morbidity was higher in the intermediate target group (adjusted odds ratio [aOR] 1.59; 95% CI: 1.04, 2.45). There was no difference in mortality between groups (aOR 0.81; 95% CI: 0.59, 1.11), in NEC, treated retinopathy, or brain injury. On subgroup analysis, restricting data to sites which switched targets during the study, intermediate saturation targets were associated with lower rates of BPD (aOR 0.45; 95% CI: 0.28, 0.72).
CONCLUSIONS: For neonates <29 weeks\' gestation, intermediate saturation target was associated with higher odds of survival without major morbidity compared to higher oxygen saturation target.
METHODS: Cohort analysis of eligible preterm infants born <29 weeks\' gestation admitted between 2011 and 2018 to centers submitting data to the Canadian Neonatal Network (CNN) database. Site questionnaires to determine saturation targets, alarm settings, and date of change, allowed assignation of centers to intermediate (88-93%) or high (90-95%) saturation targets. A 6-month washout period was applied to sites which switched targets during the study period. Our primary outcome was survival free of major morbidity. Secondary outcomes were death, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), treated retinopathy of prematurity, and evidence of brain injury during admission. Generalized estimating equations were applied to compensate for demographic differences and site practices.
RESULTS: There were 2,739 infants in the high (mean gestational age [GA] 26 ± 1.6 weeks) and 6,813 infants in the intermediate (mean GA 26.2 ± 1.6 weeks) saturation target group. Survival without morbidity was higher in the intermediate target group (adjusted odds ratio [aOR] 1.59; 95% CI: 1.04, 2.45). There was no difference in mortality between groups (aOR 0.81; 95% CI: 0.59, 1.11), in NEC, treated retinopathy, or brain injury. On subgroup analysis, restricting data to sites which switched targets during the study, intermediate saturation targets were associated with lower rates of BPD (aOR 0.45; 95% CI: 0.28, 0.72).
CONCLUSIONS: For neonates <29 weeks\' gestation, intermediate saturation target was associated with higher odds of survival without major morbidity compared to higher oxygen saturation target.
摘要：
背景：对于极早产儿，最佳氧饱和度目标仍然未知。
方法：对2011年至2018年间出生的妊娠29周的合格早产儿进行队列分析，这些早产儿向加拿大新生儿网络（CNN）数据库提交数据。确定饱和目标的现场问卷，报警设置,和更改日期，允许将中心分配到中等（88-93％）或高（90-95％）饱和目标。将6个月的清除期应用于在研究期间转换目标的位点。我们的主要结果是无主要发病率的生存率。次要结果是死亡，坏死性小肠结肠炎（NEC），支气管肺发育不良（BPD），治疗的早产儿视网膜病变，以及入院期间脑损伤的证据。应用广义估计方程来补偿人口统计学差异和现场实践。
结果：在高（平均胎龄[GA]26±1.6周）中，有2,739名婴儿，在中等（平均GA26.2±1.6周）饱和目标组中，有6,813名婴儿。中间目标组的无发病率生存率较高(调整后比值比[aOR]1.59;95%CI:1.04,2.45)。组间死亡率无差异(aOR为0.81;95%CI:0.59,1.11),在NEC,治疗的视网膜病变，或脑损伤。关于子群分析，将数据限制在研究期间切换目标的地点，中等饱和度指标与较低的BPD发生率相关(aOR为0.45;95%CI:0.28,0.72).
结论：对于妊娠29周的新生儿，与较高的氧饱和度目标相比,中等饱和度目标与较高的无主要发病率生存率相关.
方法：对2011年至2018年间出生的妊娠29周的合格早产儿进行队列分析，这些早产儿向加拿大新生儿网络（CNN）数据库提交数据。确定饱和目标的现场问卷，报警设置,和更改日期，允许将中心分配到中等（88-93％）或高（90-95％）饱和目标。将6个月的清除期应用于在研究期间转换目标的位点。我们的主要结果是无主要发病率的生存率。次要结果是死亡，坏死性小肠结肠炎（NEC），支气管肺发育不良（BPD），治疗的早产儿视网膜病变，以及入院期间脑损伤的证据。应用广义估计方程来补偿人口统计学差异和现场实践。
结果：在高（平均胎龄[GA]26±1.6周）中，有2,739名婴儿，在中等（平均GA26.2±1.6周）饱和目标组中，有6,813名婴儿。中间目标组的无发病率生存率较高(调整后比值比[aOR]1.59;95%CI:1.04,2.45)。组间死亡率无差异(aOR为0.81;95%CI:0.59,1.11),在NEC,治疗的视网膜病变，或脑损伤。关于子群分析，将数据限制在研究期间切换目标的地点，中等饱和度指标与较低的BPD发生率相关(aOR为0.45;95%CI:0.28,0.72).
结论：对于妊娠29周的新生儿，与较高的氧饱和度目标相比,中等饱和度目标与较高的无主要发病率生存率相关.
