Achieved oxygen saturations and risk for bronchopulmonary dysplasia with pulmonary hypertension in preterm infants

Abstract

Objective: Characterisation of oxygen saturation (SpO₂)-related predictors that correspond with both bronchopulmonary dysplasia-associated pulmonary hypertension (BPD-PH) development and survival status in infants with BPD-PH may improve patient outcomes. This investigation assessed whether (1) infants with BPD-PH compared with infants with BPD alone, and (2) BPD-PH non-survivors compared with BPD-PH survivors would (a) achieve lower SpO₂ distributions, (b) have a higher fraction of inspired oxygen (FiO₂) exposure and (c) have a higher oxygen saturation index (OSI).

Design: Case-control study between infants with BPD-PH (cases) and BPD alone (controls) and by survival status within cases.

Setting: Single-centre study in the USA.

Patients: Infants born at <29 weeks' gestation and on respiratory support at 36 weeks' postmenstrual age.

Exposures: FiO₂ exposure, SpO₂ distributions and OSI were analysed over the week preceding BPD-PH diagnosis.

Main outcomes and measures: BPD-PH, BPD alone and survival status in infants with BPD-PH.

Results: 40 infants with BPD-PH were compared with 40 infants with BPD alone. Infants who developed BPD-PH achieved lower SpO₂ compared with infants with BPD (p<0.001), were exposed to a higher FiO₂ (0.50 vs 0.34; p=0.02) and had a higher OSI (4.3 vs 2.6; p=0.03). Compared with survivors, infants with BPD-PH who died achieved a lower SpO₂ (p<0.001) and were exposed to a higher FiO₂ (0.70 vs 0.42; p=0.049).

Conclusions: SpO₂-related predictors differed between infants with BPD-PH and BPD alone and among infants with BPD-PH by survival status. The OSI may provide a non-invasive predictor for BPD-PH in preterm infants.

Keywords: Intensive Care Units, Neonatal; Neonatology; Respiratory Medicine.