The use of supplemental oxygen in preterm infants continues to be a challenge as sustained low and high oxygen, and fluctuations in oxygen have been implicated in infant morbidity. In a large multi-center trial (Surfactant, Positive Pressure, and Oxygenation Randomized Trial or SUPPORT), preterm infants randomized to a low level of oxygen revealed an unexpected increase in infant mortality. In addition, data in a subcohort of infants enrolled in the trial showed a higher incidence of fluctuations in oxygen levels, or intermittent hypoxia (IH) events, in the low oxygen saturation target group. Therefore, although the cause for the increased infant mortality is unknown, intermittent hypoxia may have played a key role. Our objective for this proposal is to quantify patterns (incidence, duration, severity an timing) of intermittent hypoxia and their interaction with baseline oxygen saturation in infants who died compared to infants who survived. Existing continuous pulse oximetry recordings from the SUPPORT trial will be reviewed for infants who died and compared to SUPPORT trial infants who survived. A novel computer program and techniques developed by our group will be used to analyze both baseline oxygen saturation and the incidence and patterns of oxygen fluctuations on a daily basis to identify variations in oxygenation associated with infant mortalit. Early identification of risk patterns of oxygen fluctuations may lead to timely intervention to reduce infant mortality in this high risk cohort.
The purpose of the proposal is to identify differences in fluctuations in oxygenation and their accompanying interaction with baseline oxygen saturation associated with mortality in preterm infants. Earlier recognition of these at risk patterns may improve timely clinical intervention to reduce the incidence of preterm infant death.
|Di Fiore, Juliann M; Martin, Richard J; Li, Hong et al. (2017) Patterns of Oxygenation, Mortality, and Growth Status in the Surfactant Positive Pressure and Oxygen Trial Cohort. J Pediatr 186:49-56.e1|
|Walsh, Michele C; Di Fiore, Juliann M; Martin, Richard J et al. (2016) Association of Oxygen Target and Growth Status With Increased Mortality in Small for Gestational Age Infants: Further Analysis of the Surfactant, Positive Pressure and Pulse Oximetry Randomized Trial. JAMA Pediatr 170:292-4|