325 - Oxygenation at 5 minutes as a predictor and comparison to Apgar score for preterm infants

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 325
Publication Number: 325.348

Henry Lee, University of California, San Diego School of Medicine, San Diego, CA, United States; Xin Cui, Stanford University School of Medicine, Palo Alto, CA, United States; Anup Katheria, Sharp Mary Birch Neoanatal Research Institute, University of California, San Diego School of Medicine, San Diego, CA, United States

Presenting Author(s)

Henry Lee, MD (he/him/his)

Professor
University of California, San Diego School of Medicine
San Diego, California, United States

Background: The optimal oxygen concentration and target oxygen saturation for preterm infants right after delivery continues to a knowledge gap that is becoming narrower but still requires further study, particularly in population-based settings.

Objective:

To examine distribution of FiO2 and oxygen saturation (SaO2) at 5 minutes for very low birth weight infants and assess correlation of these predictors with intraventricular hemorrhage and mortality in very low birth weight infants, with 5-minute Apgar score as a reference for comparison.

Design/Methods:

Across 9 hospitals in the California Perinatal Quality Care Collaborative from 2020-2021, data were collected at 5 minutes of age on SaO2 measurement and FiO2 delivery for infants with birth weight < 1500 grams or gestational age < 32 weeks. Standardized data collection included Apgar score, intraventricular hemorrhage, and in-hospital mortality. Correlations were assessed using Pearson correlation. Models combining variables and adjusting for gestational age estimated odds ratios (ORs) with confidence intervals (Cis).

Results:

FiO2 and SaO2 at 5 minutes varied widely across the cohort of 570 infants (Figures 1 and 2). the correlation coefficient between FiO2 and SaO2 was -0.5081. With adjustment for gestational age, five minute Apgar score 0-3 (OR 2.46, 95% CI 1.01, 6.01) and Apgar score 4-6 (OR 2.17, 95% CI 1.04, 4.55) were associated with severe intraventricular hemorrhage. FiO2 61-100% compared to FiO2 21-30% (OR 1.61, 95% CI 0.45, 5.79) was positively associated and FiO2 31-60% (0.76, 95% CI 0.18, 3.20) compared to 21-30% were not significantly associated with severe intraventricular hemorrhage. SaO2 0-60% (OR 2.72, 95% CI 0.91, 8.11) and 61-80% (OR 3.12, 95% CI 0.83, 11.77) compared to 81-100% were not significantly associated with severe intraventricular hemorrhage. Multivariable models combining Apgar score and FiO2 or SaO2 led to attenuation of all variables to be not statistically significant in prediction except for gestational age. For death prior to hospital discharge, Apgar score at 5 minutes of 0-3 compared to 7-10 was significantly associated (OR 2.94, 1.44, 6.03). In multivariable logistic regression model, low SaO2 and high FIO2 were positively associated with death, but not statistically significant.

Conclusion(s): While more objective in nature than Apgar score, FiO2 and SaO2 at 5 minutes may have partial but not full ability to predict morbidity and mortality in preterm infants.
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