Association between Intermittent Hypoxemia and Severe Bronchopulmonary Dysplasia in Preterm Infants
Authors: Erik A. Jensen, Robin K. Whyte, Barbara Schmidt, Dirk Bassler, Nestor E. Vain, Robin S. Roberts, Prakesh Shah, Leanne Brown, Lisa Wenger, Samantha Frye, Francesca Imbesi, Edmond Kelly, Judy D’Ilario, Madan Roy, Joanne Dix, Beth Adams, Janice Cairnie, Patrice Gillie, Elizabeth V. Asztalos, Marilyn Hyndman, Maralyn Lacy, Denise Hohn, Laura Cooper Kruk, Soraya Abbasi, Toni Mancini, Emidio Sivieri, Kathleen Finnegan, Aida Bairam, Sylvie Bélanger, Marianne Deschenes, Annie Fraser, JoAnn Harrold, Jane Frank, Julie Barden, Michael Vincer, Sharon Stone, Yacov Rabi, Reg Sauve, Danielle Cyr, Heather Christianson, Deborah Anseeuw-Deeks, Dianne Creighton, Alfonso Solimano, Lindsay Colby, Arsalan Butt, Anne Synnes, Meredith Peterson, Aasma Chaudhary, Hallam Hurt, Danielle Foy, Kristina Ziolkowski, Marsha Gerdes, Judy Bernbaum, Abraham Peliowski, Manoj Kumar, Leonora Hendson, Melba Athaide, Jill Tomlinson, Christian F. Poets, Jutta Armbruster, Cecilia Garcia, Vanesa DiGruccio, Fernanda Tamanaha, Noemí Jacobi, Silvia Garcia, Norma Vivas, Cristina Osio, Shanthy Sridhar, Aruna Parekh, Rose McGovern, Shmuel Arnon, Michelle Meyer, Rachel Poller, Nabeel Ali, May Khairy, Isabelle Paquet, Larissa Perepolkin, Patricia Grier, Sadia Wali, Mary Seshia, Diane Moddemann, John Minski, Valerie Cook, Kim Kwiatkowski, Karen A. H. Penner, Debbie Williams, Laurentiu Givelichian, Koravangattu Sankaran, Cindy Thiel, David Bader, Bella Sandler, Aaron Chiu, Dayle Everatt, Naomi Granke, Agneta Golan, Esther Goldstein, Shlomith Dadoun, Riitta Vikevainen, Hanna Kallankari, Tuula Kaukola, Mikko Hallman, Keith Barrington, Julie Lavoie, Elizabeth V. Asztalos, Karen A. H. Penner, William Fraser, Deborah J. Davis, George Wells, Lorrie Costantini, Wendy Yacura, Bronwyn Gent, Harvey Nelson
Journal: American Journal of Respiratory and Critical Care Medicine (2021)

Rationale: Bronchopulmonary dysplasia increases the risk of disability in extremely preterm infants. Although the pathophysiology remains uncertain, prior exposure to intermittent hypoxemia may play a role in this relationship. Objectives: To determine the association between prolonged episodes of intermittent hypoxemia and severe bronchopulmonary dysplasia. Methods: A post hoc analysis of extremely preterm infants in the Canadian Oxygen Trial who survived to 36 weeks' postmenstrual age was performed. Oxygen saturations <80% for ⩾1 minute and the proportion of time per day with hypoxemia were quantified using continuous pulse oximetry data that had been sampled every 10 seconds from within 24 hours of birth until 36 weeks' postmenstrual age. The study outcome was severe bronchopulmonary dysplasia as defined in the 2001 NIH Workshop Summary. Measurements and Main Results: Of 1,018 infants, 332 (32.6%) developed severe bronchopulmonary dysplasia. The median number of hypoxemic episodes ranged from 0.8/day (interquartile range, 0.2–1.1) to 60.2/day (interquartile range, 51.4–70.3) among the least and most affected 10% of infants. Compared with the lowest decile of exposure to hypoxemic episodes, the adjusted relative risk of severe bronchopulmonary dysplasia increased progressively from 1.72 (95% confidence interval, 1.55–1.90) at the 2nd decile to 20.40 (95% confidence interval, 12.88–32.32) at the 10th decile. Similar risk gradients were observed for time in hypoxemia. Significant differences in the rates of hypoxemia between infants with and without severe bronchopulmonary dysplasia emerged within the first week after birth. Conclusions: Prolonged intermittent hypoxemia beginning in the first week after birth was associated with an increased risk of developing severe bronchopulmonary dysplasia among extremely preterm infants. Clinical trial registered with www.isrctn.com (ISRCTN62491227) and www.clinicaltrials.gov (NCT00637169).