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Hypoxemia at birth in extremely preterm infants linked to later mortality
Extremely preterm infants who experience episodes of hypoxemia or bradycardia within the neonatal period have an increased risk for death or disability at 18 months, according to recent study results.
“Among extremely preterm infants who survived to 36 weeks’ postmenstrual age, prolonged hypoxemic episodes during the first 2 to 3months after birth were associated with adverse 18- month outcomes,” Christian F. Poets, MD, of the department of neonatology at the Tuebingen University Hospital, Germany, and colleagues wrote. “The risk of this outcome increased with the percentage of time the infants experienced intermittent hypoxemia.”
The researchers analyzed data regarding 1,019 extremely preterm infant patients from 25 international hospitals, collected between 2006 and 2010. Follow-up data were gathered at 36 weeks, between 2008 and 2012. The researchers used follow-up assessment data to determine whether death or disability, such as motor impairment, hearing impairment, sight impairment or cognitive delay, were present at 36 weeks.
Study results showed that severe hypoxemia episodes within the first few months of birth were associated with a 56.5% increase in risk for death or disability at 18 months, whereas moderate to low episodes of hypoxemia were associated with a 36.9% increase in risk (RR = 1.53; 95% CI, 1.21-1.94).
Researchers noted that risk for death or disability was only significant in cases of hypoxemia lasting longer than 1 minute.
“If these observations are confirmed in future studies, further research on the prevention of such episodes will be needed,” Poets and colleagues wrote.
In a related editorial, Lex W. Doyle, MD, of the University of Melbourne, Australia, described the potential value of this research and the need for more focused long-term research on the effects of hypoxemia on extremely preterm infants.
“[This research] must be evaluated in rigorous randomized clinical trials to minimize exposure to therapies that are useless or even harmful,” Doyle wrote. “Such trials should have long-term developmental outcome as the primary endpoint, rather than short-term endpoints, such as a reduction in the number or duration of hypoxemic episodes. Neonatal intensive care is littered with examples of treatments that were introduced based on observational data or even no data, only to be proven to be disastrous when tested properly in randomized clinical trials. In the meantime, other treatments known from randomized clinical trials to improve long-term neurodevelopmental outcome for extremely preterm infants, such as magnesium sulfate before birth, regular doses of caffeine, or developmental care interventions after discharge, should be maximized.” – by David Costill
Disclosure: Poets reports receiving grants from Chiesi Farmaceutici SpA and Masimo. Please see the study for a full list of all other researchers’ financial disclosures.
