{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T10:56:10Z","timestamp":1793444170441,"version":"4.5.0"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Exposure to supraphysiologic oxygen concentrations, or hyperoxia, during neonatal cardiopulmonary bypass (CPB) has been associated with worse outcomes in single\u2010center studies. We aimed to describe variation in oxygen exposure during CPB and determine if hyperoxia is associated with worse outcomes in a multicenter cohort of neonates undergoing cardiac surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We conducted a retrospective study of neonates who underwent surgery with CPB between January 2021 and December 2022 at 29 centers. Primary outcomes were operative mortality and major adverse cardiovascular events, which included cardiopulmonary resuscitation, extracorporeal support, stroke, and mortality. Logistic regression assessed the associations between median partial pressure of oxygen in arterial blood (PaO\n                      <jats:sub>2<\/jats:sub>\n                      ) during CPB and outcomes in the entire cohort and subset of patients with single\u2010ventricle (SV) anatomy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We analyzed 1175 neonates, including 357 with SV anatomy. Median PaO\n                      <jats:sub>2<\/jats:sub>\n                      during CPB was 296\u2009mm\u2009Hg (range: 54\u2013800), with significant variation across centers (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). There were 54 deaths (5%) and 203 major adverse cardiovascular events (17%). No patients with PaO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;200\u2009mm\u2009Hg (n=161) died, and PaO\n                      <jats:sub>2<\/jats:sub>\n                      &gt;221\u2009mm\u2009Hg demonstrated modest mortality prediction (96% sensitivity, 19% specificity). In multivariable analysis, before adjustment for center, PaO\n                      <jats:sub>2<\/jats:sub>\n                      &gt;221\u2009mm\u2009Hg was significantly associated with mortality and major adverse cardiovascular events in all patients and patients with SV anatomy. After adjustment for center, associations between hyperoxia and mortality (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.053) or major adverse cardiovascular events (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.08) were not significant in the entire cohort but remained significant in patients with SV anatomy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">We observed significant variation in oxygen exposure during neonatal CPB across centers and significant associations between hyperoxia and worse outcomes, particularly in neonates with SV anatomy.<\/jats:p>\n                  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