title: Oxygen Saturation Targets in Preterm Infants and Outcomes at 18-24 Months: A Systematic Review.
abstract: The optimal oxygen saturation target for extremely preterm infants remains unclear.
  
  
  
  To systematically review evidence evaluating the effect of lower (85%-89%) versus higher (91%-95%) pulse oxygen saturation (Spo2) target on mortality and neurodevelopmental impairment (NDI) at 18 to 24 months.
  
  
  
  Electronic databases and all published randomized trials evaluating lower versus higher Spo2target in preterm infants.
  
  
  
  A total of 2896 relevant citations were identified; 5 trials were included in the final analysis.
  
  
  
  Data from 5 trials were analyzed for quality of evidence and risk of bias.
  
  
  
  Limitations include heterogeneity in age at enrollment and comorbidities between trials and change in oximeter algorithm midway through 3 trials.
  
  
  
  There was no difference in the incidence of primary outcome (death/NDI at 18-24 months) in the 2 groups; risk ratio,1.05, 95% confidence interval 0.98-1.12, P = .18. Mortality before 18 to 24 months was higher in the lower-target group (risk ratio,1.16, 95% confidence interval 1.03-1.31, P = .02). Rates of NDI and severe visual loss did not differ between the 2 groups. Proportion of time infants spent outside the target range while on supplemental oxygen ranged from 8.2% to 27.4% <85% and 8.1% to 22.4% >95% with significant overlap between the 2 groups.
  
  
  
  There was no difference in primary outcome between the 2 Spo2target groups. The collective data suggest that risks associated with restricting the upper Spo2target limit to 89% outweigh the benefits. The quality of evidence was moderate. We speculate that a wider target range (lower alarm limit, 89% and upper, 96%) may increase time spent within range, but the safety profile of this approach remains to be determined.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Veterans Affairs Medical Center, Buffalo, New York.|Department of Clinical Epidemiology and Biostatistics, McMaster's University, Hamilton, Ontario, Canada.
authors.forename: Veena
authors.initials: V
authors.lastname: Manja
authors.affiliation: Department of Pediatric Research, Oslo University Hospital, University of Oslo, Oslo, Norway; and.
authors.forename: Ola D
authors.initials: OD
authors.lastname: Saugstad
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Woman and Children's Hospital of Buffalo, University at Buffalo, Buffalo, New York slakshmi@buffalo.edu.
authors.forename: Satyan
authors.initials: S
authors.lastname: Lakshminrusimha
mesh_terms: D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature / Q000097:blood*; D007231:Infant, Newborn; D065886:Neurodevelopmental Disorders / Q000097:blood / Q000401:mortality; D017063:Outcome Assessment, Health Care; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D015996:Survival Rate
chemical_list: D010100:Oxygen