Patterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort

Objective To characterize actual achieved patterns of oxygenationin infants born appropriate vs smallfor gestational age(SGA) randomized to a lower (85-89%) vs higher (91%-95%) oxygen saturationtarget in the Surfactant Positive Pressureand OxygenTrial. To determine the association between achieved oxygen saturationlevels and survival in infants born appropriate vs SGA enrolled in the Surfactant Positive Pressureand OxygenTrial. Study design Median oxygen saturationand intermittent hypoxemiaevents ( 0/7 -27 6/7  weeks of gestation while receiving supplemental oxygenduring the first 3 days of life. Results Lower target infants who were smallfor gestational agehad the lowest oxygen saturationand highest incidence of intermittent hypoxemiaduring the first 3 days of life. The lowest quartile of oxygen saturation(≤92%) during the first 3 days of life was associated with lower 90-day survival for both infants born appropriate and SGA. An increased incidence of intermittent hypoxemiaevents during the first 3 days of life was associated with lower 90-day survival only in infants born SGA. Conclusion Lower achieved oxygen saturationduring the first 3 days of life was associated with lower 90-day survival in extremely preterm infants. Infants born SGA had enhanced vulnerability to lower oxygen saturationtargets as evidenced by lower achieved oxygen saturationand an association between increased intermittent hypoxemiaevents and lower survival. Trial registrationClinicalTrials.gov : NCT00233324 .