Eliminating sleep-associated hypoxemia improves growth in infants with bronchopulmonary dysplasia
Moyer-Mileur, L.J.; Nielson, D.W.; Pfeffer, K.D.; Witte, M.K.; Chapman, D.L.
Pediatrics 98(4 Pt 1): 779-783
1996
ISSN/ISBN: 0031-4005 PMID: 8885961 Document Number: 464150
Objective: Infants with bronchopulmonary dysplasia (BPD) have been previously reported to have a decrease in growth velocity after stopping supplemental oxygen (SO). SO was stopped after a short-term recording (20-30 minutes) of pulse oxygen saturation (SaO-2) of 92% or greater in room air. Other studies have documented that SaO-2 decreases further during feedings and sleep in infants with BPD. Two questions were asked: (1) whether short-term, awake SaO-2 studies would reliably predict prolonged sleep SaO-2; and (2) how SaO-2 sustained at 88% to 91% vs 92% or greater in room air would impact growth velocity in infants with BPD. Methodology: Short-term SaO-2 studies were prospectively compared with prolonged sleep SaO-2 (n = 63) and the growth velocity of infants who had SO discontinued after a prolonged sleep SaO-2 recording of 88% to 91% (group 1; n = 14) versus 92% or greater (group 2; n = 34) in room air. Results: Failure to maintain SaO-2 at predetermined levels occurred in 18 (29%) of 63 infants during their first prolonged sleep study. There was no correlation between short-term awake SaO-2 and prolonged sleep SaO-2 recordings (r = .02). Body weight, height, weight for height, and rate of weight gain were similar for all study infants before SO was stopped and remained constant for group 2 infants after SO was stopped. However, group 1 infants had a significant decrease in the rate of weight gain (17.3 + 13.1 vs 3.7 + 6.1 g/kg per day), and the mean z scores for weight gain and weight for height also decreased significantly for group 1 infants. Energy intake, incidence of acute infection, hematocrit values, and medication use did not differ before or after stopping SO in either group. Conclusions: This study indicated that short-term, awake SaO-2 measurements do not predict prolonged sleep SaO-2, and overall, infants with BPD continued a positive growth trend when SaO-2 remained greater than 92% during prolonged sleep.