653 - Pre-Vent study: Relationship between neonatal oxygen saturation episodes and motor impairment in infants born extremely pre-term

Publication Number: 2636.653

Angeli Mittal, Ann & Robert H. Lurie Children's Hospital of Chicago, Oak Park, IL, United States; Narayanan Krishnamurthi, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Casey Rand, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Erin Lonergan, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Ryne Estabrook, University of Illinois - Chicago, Chicago, IL, United States; Aaron Hamvas, Lurie Children's Hospital / Northwestern University, Chicago, IL, United States; Debra E. Weese-Mayer, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Raye-Ann DeRegnier, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: Extremely preterm infants frequently experience fluctuations in oxygen saturation due to immature respiratory control, lung disease, and prolonged oxygen support. Recent studies have associated oxygen desaturation and neurodevelopmental impairment, but these findings require replication. Furthermore, there is little information about potential associations between developmental outcomes and high oxygen saturation values.

Objective: To examine the relationship between fluctuations in oxygen saturation during the first eight postnatal weeks and later motor impairment in infants born extremely preterm.

Design/Methods: Continuous cardiorespiratory physiology was recorded from enrollment (1st postnatal week) through discharge in 131 infants born at 23-286/7 weeks gestational age (GA) in the Lurie site NHLBI-funded Pre-Vent study (U01 HL133704 and U01 HL133708). Duration per day (dpd) of continuous oxygen saturation episodes lasting ≥10 sec with SpO2 < 80% (Low80), < 90% (Low90), or >98% (High98; on O2 support) was calculated. The Neuro-Sensory Motor Developmental Assessment (NSMDA) and Bayley Scales of Infant and Toddler Development 3rd/4th edition were performed at 11-15 months and/or 16-22 months corrected age (CA). Motor impairment was defined as NSMDA score ≥12 (mild or greater impairment), Bayley motor score < 70 (>2 SD below mean), or diagnosis of cerebral palsy and unable to test. Infants were grouped by GA (GA < 27: 23-266/7; GA≥27: 27-286/7 weeks). A linear mixed-effects model was used to study the impact of GA and oxygen saturation episodes during the first 8 postnatal weeks on motor impairment.

Results: (Figure) At 11-15 months CA motor evaluation, GA < 27 infants had higher baseline (first 2 postnatal weeks) daily oxygen burden than GA≥27 infants: Low80 (30.1 vs 16.7 min/day; p<.05), Low90 (166.8 vs 106.3 min/day; p<.001), High98 (175.3 vs 101.6 min/day; p<.05). Infants with motor impairment also had longer baseline High98 durations (+63.1 min/day; p<.05). No significant baseline differences were seen at 16-22 months evaluation.

Conclusion(s): Infants born GA < 27 exhibited greater daily oxygen burden during early postnatal weeks, characterized by longer durations of both lower and higher saturations. Longer baseline saturations >98% were also linked to later motor impairment at 11-15 months CA. However, these physiologic differences were not linked to motor impairment at 16-22 months using the described measures, highlighting the need for longer follow-up, potentially more sensitive neuromotor assessments, and inclusion of cognitive and language outcomes to better characterize neurodevelopmental impact.

Oxygen-Related Burden by Gestational Age and Motor Impairment