New evidence will help prevent thousands of preterm babies’ deaths globally

More premature babies could survive if their levels of oxygen are kept in the top half of the previously accepted range, says new research in today’s New England Journal of Medicine.

Conducted in Australia and the UK by the BOOST-II Collaborative Groups, the trials involved 2,108 cases and confirm similar findings from a randomised controlled trial in North America.

Prior to these new findings, neonatologists had targeted hemoglobin saturations between 85% and 95% because saturations lower than 85% increased the likelihood of neurologic damage and those higher than 95% increased the risk of retinopathy in extremely pre-term infants.

The decision of how much oxygen to give has been a difficult one, because too much and too little can both cause later disability. Now the precision of the target has narrowed considerably.

“This evidence will help prevent thousands of deaths worldwide each year,” said the University of Sydney’s Professor William Tarnow-Mordi, co-principal investigator of the study.

“Now more trials are urgently needed to improve the quality of survival of premature babies. With innovative investment in clinical trial networks and point-of-care data capture, trials like these could be completed much faster, at a fraction of the cost.”

During the trials, there was a correction to the algorithm that provided data from the oxygen meters. In an extra analysis of data from only the revised oximeters in both trials, the rates of death were 24.5% in the lower-target group (144/587) and 16.9% in the higher-target group (99/586). This was a statistically significant difference (relative risk 1.45, 95% CI 1.15-1.82; P=0.001).

In post-hoc combined analyses using all oximeters, deaths were significantly higher in the lower-oxygen target group than in the higher-target group: 222/1045 (21.2%) versus 185/1045 (17.8%), relative risk 1.20, 95% CI 1.01-1.43; P=0.04.

“The success of trials like these depends on hundreds of parents and health professionals,” said Tarnow-Mordi, professor of neonatal medicine at the university’s NHMRC Clinical Trials Centre. “Thanks to their support, the outlook for very preterm babies has never been better – and continues to improve.”

(Source: The University of Sydney, New England Journal of Medicine)