{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T17:09:51Z","timestamp":1784740191270,"version":"3.55.0"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,10,24]],"date-time":"2023-10-24T00:00:00Z","timestamp":1698105600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Randomized controlled trials have indicated reduced mortality rates in very preterm infants assigned to high compared to low oxygen saturation (SpO<jats:sub>2<\/jats:sub>) target levels, accompanied by higher rates of retinopathy of prematurity and bronchopulmonary dysplasia. However, the benefit-to-harm ratio may depend on the local background mortality risk. We therefore aimed to quantify the risk\u2013benefit ratios of different SpO<jats:sub>2<\/jats:sub> target ranges in 10 tertiary newborn intensive care units (NICUs) in East Germany.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective multicenter study, 1,399 infants born between 2008 and 2012 at a gestational age between 24 0\/7 and 27 6\/7 weeks and with a birthweight below 1,250\u2005g were grouped according to the hospital's target SpO<jats:sub>2<\/jats:sub> range [high oxygen saturation group (HOSG) above 90%], low oxygen saturation group (LOSG) below 90%] and the compliance of units with their target SpO<jats:sub>2<\/jats:sub> range. The association between neonatal morbidities, neurodevelopmental outcomes, selected treatment strategies, and target SpO<jats:sub>2<\/jats:sub> ranges was calculated using chi-squared and Mann Whitney <jats:italic>U<\/jats:italic> tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nine of the ten participating NICUs met their SpO<jats:sub>2<\/jats:sub> target ranges. Five units were considered as HOSG, and five units were considered as LOSG. Necrotizing enterocolitis and intraventricular hemorrhage grade\u2009\u2265\u20092 occurred significantly more frequently in the HOSG than in the LOSG (8.4% vs. 5.1%, <jats:italic>p<\/jats:italic>\u2009=\u20090.02; and 26.6% vs. 17.7%, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.001). No significant differences in the mortality rate and the rate of retinopathy of prematurity were found.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In our patient population, a lower SpO<jats:sub>2<\/jats:sub> target range was not associated with increased safety risks in extremely preterm infants. We cannot be sure that our outcome differences are associated with differences in oxygen saturations due to the retrospective study design and the differences in site practices.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2023.1235877","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T06:11:48Z","timestamp":1698214308000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Similar adverse outcome rates with high or low oxygen saturation targets in an area with low background mortality"],"prefix":"10.3389","volume":"11","author":[{"given":"Nina","family":"Willgerodt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"B\u00fchrer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Rossi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"K\u00fchn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"R\u00fcdiger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Avenarius","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"B\u00f6ttger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk M.","family":"Olbertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Proquitte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-J\u00f6rg","family":"Bittrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland","family":"Haase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Fr\u00f6hlich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sybille","family":"H\u00f6hne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrich H.","family":"Thome","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,10,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"109","DOI":"10.4103\/2249-4847.101683","article-title":"Oxidative stress and bronchopulmonary dysplasia","volume":"1","author":"Perrone","year":"2012","journal-title":"J Clin Neonatol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1016\/j.rmed.2017.10.014","article-title":"Bronchopulmonary dysplasia: a review of pathogenesis and pathophysiology","volume":"132","author":"Kalikkot Thekkeveedu","year":"2017","journal-title":"Respir Med"},{"key":"B3","first-page":"1","article-title":"Pulse oximetry targets in extremely premature infants and associated mortality: one-size may not fit all","volume":"4","author":"Raffay","year":"2018","journal-title":"J Nat Sci"},{"key":"B4","doi-asserted-by":"publisher","first-page":"F53","DOI":"10.1136\/adc.2004.053892","article-title":"Population based study on the outcome of small for gestational age newborns","volume":"90","author":"Bartels","year":"2005","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B5","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1055\/s-2000-9423","article-title":"Neonatal outcome in growth-restricted versus appropriately grown preterm infants","volume":"17","author":"Simchen","year":"2000","journal-title":"Am J Perinatol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"246","DOI":"10.3345\/kjp.2011.54.6.246","article-title":"Outcomes of small for gestational age micropremies depending on how young or how small they are","volume":"54","author":"Yu","year":"2011","journal-title":"Korean J Pediatr"},{"key":"B7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1056\/NEJMoa041367","article-title":"Neurologic and developmental disability at six years of age after extremely preterm birth","volume":"352","author":"Marlow","year":"2005","journal-title":"N Engl J Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1097\/01.AOG.0000284447.43442.55","article-title":"Outcome at 3 years of age in a population-based cohort of extremely preterm infants","volume":"110","author":"de Groote","year":"2007","journal-title":"Obstet Gynecol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1007\/s00112-012-2800-8","article-title":"Bronchopulmonale dysplasie (BPD)","volume":"161","author":"Herting","year":"2013","journal-title":"Monatsschr Kinderheilkd"},{"key":"B10","doi-asserted-by":"publisher","first-page":"CD011190","DOI":"10.1002\/14651858.CD011190.pub2","article-title":"Effects of targeting lower versus higher arterial oxygen saturations on death or disability in preterm infants","volume":"4","author":"Askie","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"F106","DOI":"10.1136\/fn.84.2.f106","article-title":"Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation","volume":"84","author":"Tin","year":"2001","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B12","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1038\/sj.jp.7211067","article-title":"Retinopathy of prematurity and pulse oximetry: a national survey of recent practices","volume":"24","author":"Anderson","year":"2004","journal-title":"J Perinatol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"2190","DOI":"10.1001\/jama.2018.5725","article-title":"Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration","volume":"319","author":"Askie","year":"2018","journal-title":"JAMA"},{"key":"B14","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.clp.2013.09.007","article-title":"Pathogenesis and prevention of intraventricular hemorrhage","volume":"41","author":"Ballabh","year":"2014","journal-title":"Clin Perinatol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1203\/PDR.0b013e3181c1b176","article-title":"Intraventricular hemorrhage in premature infants: mechanism of disease","volume":"67","author":"Ballabh","year":"2010","journal-title":"Pediatr Res"},{"key":"B16","doi-asserted-by":"publisher","first-page":"2094","DOI":"10.1056\/NEJMoa1302298","article-title":"Oxygen saturation and outcomes in preterm infants","volume":"368","author":"Stenson","year":"2013","journal-title":"N Engl J Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2111","DOI":"10.1001\/jama.2013.5555","article-title":"Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial","volume":"309","author":"Schmidt","year":"2013","journal-title":"JAMA"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1959","DOI":"10.1056\/NEJMoa0911781","article-title":"Target ranges of oxygen saturation in extremely preterm infants","volume":"362","author":"Carlo","year":"2010","journal-title":"N Engl J Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1186\/1471-2431-11-6","article-title":"NeOProM: neonatal oxygenation prospective meta-analysis collaboration study protocol","volume":"11","author":"Askie","year":"2011","journal-title":"BMC Pediatr"},{"key":"B20","doi-asserted-by":"publisher","first-page":"101080","DOI":"10.1016\/j.siny.2020.101080","article-title":"Oxygen saturation target ranges and alarm settings in the NICU: what have we learnt from the neonatal oxygenation prospective meta-analysis (NeOProM)?","volume":"25","author":"Schmidt","year":"2020","journal-title":"Semin Fetal Neonatal Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"171","DOI":"10.33549\/physiolres.933987","article-title":"Optimal oxygen saturation in extremely premature neonates","volume":"68","author":"Zoban","year":"2019","journal-title":"Physiol Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1053","DOI":"10.1111\/dmcn.12208","article-title":"Comparison of Bayley-2 and Bayley-3 scores at 18 months in term infants following neonatal encephalopathy and therapeutic hypothermia","volume":"55","author":"Jary","year":"2013","journal-title":"Dev Med Child Neurol"},{"key":"B23","volume-title":"Bayles scales of infant development 2nd edition (BSID II)","author":"Bayley","year":"2007"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1164\/ajrccm.163.7.2011060","article-title":"Bronchopulmonary dysplasia","volume":"163","author":"Jobe","year":"2001","journal-title":"Am J Respir Crit Care Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"991","DOI":"10.1001\/archopht.123.7.991","article-title":"The international classification of retinopathy of prematurity revisited","volume":"123","year":"2005","journal-title":"Arch Ophthalmol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/S0022-3476(78)80282-0","article-title":"Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm","volume":"92","author":"Papile","year":"1978","journal-title":"J Pediatr"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00000658-197801000-00001","article-title":"Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging","volume":"187","author":"Bell","year":"1978","journal-title":"Ann Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1159\/000486751","article-title":"Oxygenation of the immature infant: a commentary and recommendations for oxygen saturation targets and alarm limits","volume":"114","author":"Saugstad","year":"2018","journal-title":"Neonatology"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.khinf.2010.03.002","article-title":"Gesundheitsberichterstattung des bundes: sterblichkeit, todesursachen und regionale unterschiede","volume":"52","author":"Gaber","year":"2011","journal-title":"Krankenhaus-Hygiene +Infektionsverh\u00fctung"},{"key":"B30","doi-asserted-by":"publisher","first-page":"233","DOI":"10.3233\/NPM-16915130","article-title":"Necrotizing enterocolitis in premature infants and newborns","volume":"9","author":"M\u03cbller","year":"2016","journal-title":"J Neonatal Perinatal Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"F188","DOI":"10.1136\/fn.82.3.f188","article-title":"Low superior vena cava flow and intraventricular haemorrhage in preterm infants","volume":"82","author":"Kluckow","year":"2000","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B32","doi-asserted-by":"publisher","first-page":"CD004454","DOI":"10.1002\/14651858.CD004454.pub3","article-title":"Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth","volume":"3","author":"Roberts","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1542\/peds.105.2.295","article-title":"Supplemental therapeutic oxygen for prethreshold retinopathy of prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. STOP ROP","volume":"105","year":"2000","journal-title":"Pediatrics"},{"key":"B34","doi-asserted-by":"publisher","first-page":"CD003482","DOI":"10.1002\/14651858.CD003482","article-title":"Supplemental oxygen for the treatment of prethreshold retinopathy of prematurity","volume":"2","author":"Lloyd","year":"2003","journal-title":"Cochrane Database Syst Rev"},{"key":"B35","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1038\/jp.2009.60","article-title":"Effects of low oxygen saturation limits on the ductus arteriosus in extremely low birth weight infants","volume":"29","author":"Noori","year":"2009","journal-title":"J Perinatol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/ppul.24193","article-title":"Target oxygen saturation and development of pulmonary hypertension and increased pulmonary vascular resistance in preterm infants","volume":"54","author":"Lalibert\u00e9","year":"2019","journal-title":"Pediatr Pulmonol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1001\/jamapediatrics.2016.0820","article-title":"Interaction of target oxygen saturation, bronchopulmonary dysplasia, and pulmonary hypertension in small for gestational age preterm neonates","volume":"170","author":"Lakshminrusimha","year":"2016","journal-title":"JAMA Pediatr"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1542\/peds.2016-1609","article-title":"Oxygen saturation targets in preterm infants and outcomes at 18\u201324 months: a systematic review","volume":"139","author":"Manja","year":"2017","journal-title":"Pediatrics"},{"key":"B39","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1001\/jamapediatrics.2014.3307","article-title":"Oxygen saturation target range for extremely preterm infants: a systematic review and meta-analysis","volume":"169","author":"Manja","year":"2015","journal-title":"JAMA Pediatr"},{"key":"B40","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1159\/000524455","article-title":"Population-based outcome data of extremely preterm infants in Germany during 2010\u20132017","volume":"119","author":"B\u00fchrer","year":"2022","journal-title":"Neonatology"},{"key":"B41","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1159\/000528914","article-title":"European consensus guidelines on the management of respiratory distress syndrome: 2022 update","volume":"120","author":"Sweet","year":"2023","journal-title":"Neonatol"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1235877\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T06:11:54Z","timestamp":1698214314000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1235877\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,24]]},"references-count":41,"alternative-id":["10.3389\/fped.2023.1235877"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1235877","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,24]]},"article-number":"1235877"}}