{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:38:13Z","timestamp":1792791493849,"version":"4.5.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n According to the Neonatal Oxygenation Prospective Meta-Analysis, a higher oxygen saturation as measured by pulse oximetry (Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n ) target range, compared with a lower Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n target, may reduce mortality but increase the risk of treated retinopathy of prematurity (ROP). Choosing a target range at an individual center may depend on the local baseline risks and the value placed on prioritizing survival over the risk of severe retinopathy.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To estimate trade-offs between mortality and treated ROP associated with Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n targeting and the association between variation in baseline risks and these trade-offs.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This decision analytical modeling study used US national birth data and the Vermont Oxford Network database (2019-2023), incorporating gestational age (GA) 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 (GA 23-27 weeks). The data were analyzed between January and August 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n \n High Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n (91%-95%) vs low Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n (85%-89%) target ranges.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was the risk trade-off ratio (RTOR) of additional cases of treated ROP per death averted. Estimates of outcomes comparing universal adoption of the high or low Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n targets were summarized using results of a probabilistic sensitivity analysis. Scenarios were also included that incorporated selective adoption of high or low targets based on performance quartiles.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 19\u202f050 simulated infants (2372 [12.5%] born at GA 23 weeks, 3253 [17.1%] at GA 24 weeks, 3809 [20.0%] at GA 25 weeks, 4357 [22.9%] at GA 26 weeks, and 5259 [27.6%] at GA 27 weeks), which approximated the distribution of extremely preterm births in the US, universal adoption of the higher Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n target range was associated with a mean of 638 fewer deaths (95% uncertainty interval [UI], \u2212363 to \u2212934 deaths) and a mean of 551 additional cases (95% UI, 435-659 additional cases) of treated ROP. The mean RTOR with the high Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n target range was 0.91 (95% UI, 0.61-1.43). 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 ROP (1st quartile) and 2.52 (95% UI, 1.39-4.72) for centers with the highest mortality (1st quartile) and lowest risk of treated ROP (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 ROP were acceptable for each death averted.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n This decision analytical modeling study of a US cohort of extremely preterm infants found that the RTOR for treated ROP and mortality during Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n targeting varied by GA and local baseline risks. This decision analysis may help inform the choice of Sp\n o<\/jats:sc>\n 2<\/jats:sub>\n target ranges in individual clinical centers.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.24727","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:00:34Z","timestamp":1784646034000},"page":"e2624727","source":"Crossref","is-referenced-by-count":1,"title":["Modeling Oxygen Saturation Targets, Mortality, and Retinopathy Among Extremely Preterm Infants"],"prefix":"10.1001","volume":"9","author":[{"given":"Brian C.","family":"King","sequence":"first","affiliation":[{"name":"Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A. F.","family":"Zupancic","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts"},{"name":"Division of Newborn Medicine, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika M.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington"},{"name":"Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington"},{"name":"Department of Mathematics and Statistics, College of Engineering and Mathematical Sciences, University of Vermont, Burlington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle E. Y.","family":"Ehret","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington"},{"name":"Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"Horbar","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington"},{"name":"Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roger F.","family":"Soll","sequence":"additional","affiliation":[{"name":"Vermont Oxford Network, Burlington"},{"name":"Department of Pediatrics, Robert Larner College of Medicine, University of Vermont, Burlington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara K.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University, 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