Modeling Oxygen Saturation Targets, Mortality, and Retinopathy Among Extremely Preterm Infants.
Higher oxygen saturation targets in extremely preterm infants were linked to fewer deaths but more treated retinopathy of prematurity (a vision-threatening eye disease).
Modeling Oxygen Saturation Targets, Mortality, and Retinopathy Among Extremely Preterm Infants.
To estimate trade-offs between mortality and treated retinopathy of prematurity associated with Spo2 targeting and the association between variation in baseline risks and these trade-offs.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical modeling study used US national birth data and the Vermont Oxford Network database (2019-2023), incorporating gestational age (gestational age) and 16 performance subgroups (based on quartiles of center-specific mortality and retinopathy risks), to simulate an annual birth cohort of infants born extremely preterm (gestational age 23-27 weeks).
On average, under 1 extra case of treated eye disease occurred for each death prevented by higher oxygen targets.
Across performance subgroups, RTORs were 0.16 (95% UI, 0.00-0.40) in centers with the highest risk of mortality (4th quartile) and lowest risk of treated retinopathy of prematurity (1st quartile) and 2.52 (95% UI, 1.39-4.72) for centers with the highest mortality (1st quartile) and lowest risk of treated retinopathy of prematurity (4th quartile).
Selective adoption of target ranges was favored in 50% of simulations if 2 cases of treated retinopathy per death averted were considered acceptable.
Universal adoption of the high target range was favored in more than 90% of simulations if 4 or more cases of treated retinopathy of prematurity were acceptable for each death averted.
This decision analytical modeling study of a US cohort of extremely preterm infants found that the risk trade-off ratio for treated retinopathy of prematurity and mortality during Spo2 targeting varied by gestational age and local baseline risks.
This decision analysis may help inform the choice of Spo2 target ranges in individual clinical centers.