title: Oxygen saturation and outcomes in preterm infants.
abstract: BACKGROUND
  The clinically appropriate range for oxygen saturation in preterm infants is unknown. Previous studies have shown that infants had reduced rates of retinopathy of prematurity when lower targets of oxygen saturation were used.
  
  
  METHODS
  In three international randomized, controlled trials, we evaluated the effects of targeting an oxygen saturation of 85 to 89%, as compared with a range of 91 to 95%, on disability-free survival at 2 years in infants born before 28 weeks' gestation. Halfway through the trials, the oximeter-calibration algorithm was revised. Recruitment was stopped early when an interim analysis showed an increased rate of death at 36 weeks in the group with a lower oxygen saturation. We analyzed pooled data from patients and now report hospital-discharge outcomes.
  
  
  RESULTS
  A total of 2448 infants were recruited. Among the 1187 infants whose treatment used the revised oximeter-calibration algorithm, the rate of death was significantly higher in the lower-target group than in the higher-target group (23.1% vs. 15.9%; relative risk in the lower-target group, 1.45; 95% confidence interval [CI], 1.15 to 1.84; P=0.002). There was heterogeneity for mortality between the original algorithm and the revised algorithm (P=0.006) but not for other outcomes. In all 2448 infants, those in the lower-target group for oxygen saturation had a reduced rate of retinopathy of prematurity (10.6% vs. 13.5%; relative risk, 0.79; 95% CI, 0.63 to 1.00; P=0.045) and an increased rate of necrotizing enterocolitis (10.4% vs. 8.0%; relative risk, 1.31; 95% CI, 1.02 to 1.68; P=0.04). There were no significant between-group differences in rates of other outcomes or adverse events.
  
  
  CONCLUSIONS
  Targeting an oxygen saturation below 90% with the use of current oximeters in extremely preterm infants was associated with an increased risk of death. (Funded by the Australian National Health and Medical Research Council and others; BOOST II Current Controlled Trials number, ISRCTN00842661, and Australian New Zealand Clinical Trials Registry numbers, ACTRN12605000055606 and ACTRN12605000253606.).
authors: Ben J
authors: BJ
authors: Stenson
authors: William O
authors: WO
authors: Tarnow-Mordi
authors: Brian A
authors: BA
authors: Darlow
authors: John
authors: J
authors: Simes
authors: Edmund
authors: E
authors: Juszczak
authors: Lisa
authors: L
authors: Askie
authors: Malcolm
authors: M
authors: Battin
authors: Ursula
authors: U
authors: Bowler
authors: Roland
authors: R
authors: Broadbent
authors: Pamela
authors: P
authors: Cairns
authors: Peter Graham
authors: PG
authors: Davis
authors: Sanjeev
authors: S
authors: Deshpande
authors: Mark
authors: M
authors: Donoghoe
authors: Lex
authors: L
authors: Doyle
authors: Brian W
authors: BW
authors: Fleck
authors: Alpana
authors: A
authors: Ghadge
authors: Wendy
authors: W
authors: Hague
authors: Henry L
authors: HL
authors: Halliday
authors: Michael
authors: M
authors: Hewson
authors: Andrew
authors: A
authors: King
authors: Adrienne
authors: A
authors: Kirby
authors: Neil
authors: N
authors: Marlow
authors: Michael
authors: M
authors: Meyer
authors: Colin
authors: C
authors: Morley
authors: Karen
authors: K
authors: Simmer
authors: Win
authors: W
authors: Tin
authors: Stephen P
authors: SP
authors: Wardle
authors: Peter
authors: P
authors: Brocklehurst
mesh_terms: D000465:Algorithms; D002138:Calibration; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007226:Infant Mortality; D062071:Infant, Extremely Premature / Q000097:blood*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods*; D012178:Retinopathy of Prematurity / Q000209:etiology / Q000517:prevention & control*
chemical_list: D010100:Oxygen