Achieved oxygen saturations and risk for bronchopulmonary dysplasia with pulmonary hypertension in preterm infants

Objective Characterisation of oxygen saturation (SpO(2))-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 SpO(2) distributions, (b) have a higher fraction of inspired oxygen (FiO(2)) 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 FiO(2) exposure, SpO(2) 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 SpO(2) compared with infants with BPD (p<0.001), were exposed to a higher FiO(2) (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 SpO(2) (p<0.001) and were exposed to a higher FiO(2) (0.70 vs 0.42; p=0.049). Conclusions SpO(2)-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.