Achieved Oxygen Saturations and Risk for Bronchopulmonary Dysplasia-Associated Pulmonary Hypertension in Preterm Infants

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.