Simplified bedside assessment of pulmonary gas exchange in very preterm infants at 36 weeks' postmenstrual age.

Thorax
Benjamin StoecklinJ Jane Pillow

Abstract

We aimed to develop and validate a prediction table for a simplified measure of rightward shift of the fetal oxyhaemoglobin saturation (SpO2) versus inspired oxygen pressure (P IO2) curve as an objective marker of lung disease severity in very preterm infants, independent of unit altitude or oxygen prescribing policies. Very preterm infants (n=219) had an oxygen reduction test at median (IQR) test age of 354 (345-360) weeks' postmenstrual age (PMA). Shift was derived from at least three paired SpO2 versus P IO2 measurements using a computer algorithm, using the fetal oxyhaemoglobin dissociation curve as the reference. Linear regression of resultant shift values enabled construction of a table to predict shift using a single paired SpO2 versus P IO2 measurement, validated subsequently in a separate infant cohort using Bland-Altman analysis. Receiver operating curve analysis provided threshold values equating to a clinical diagnosis of mild bronchopulmonary dysplasia (BPD) or moderate to severe BPD. The median (IQR) age of 63 infants in the validation cohort was 360 (356-362) weeks' PMA. Mean difference (95% CI) between predicted and measured shift was 2.1 (-0.8% to 4.9%) with wide limits of agreement (-20.7% to 24.8%). Predicted...Continue Reading

References

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