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Neuropsychological Outcomes in Extremely Preterm Preschoolers Exposed to Tiered Low Oxygen Targets: An Observational Study

Published online by Cambridge University Press:  08 December 2015

Ida Sue Baron ,
Brandi A. Weiss ,
Robin Baker ,
Margot D. Ahronovich ,
Fern R. Litman  and
Rajiv Baveja
Ida Sue Baron*
Affiliation:
Fairfax Neonatal Associates, Inova Children’s Hospital, Falls Church, Virginia
Brandi A. Weiss
Affiliation:
Department of Educational Leadership, The George Washington University, Washington, DC
Robin Baker
Affiliation:
Fairfax Neonatal Associates, Inova Children’s Hospital, Falls Church, Virginia
Margot D. Ahronovich
Affiliation:
Fairfax Neonatal Associates, Inova Children’s Hospital, Falls Church, Virginia
Fern R. Litman
Affiliation:
Fairfax Neonatal Associates, Inova Children’s Hospital, Falls Church, Virginia
Rajiv Baveja
Affiliation:
Fairfax Neonatal Associates, Inova Children’s Hospital, Falls Church, Virginia
*
Correspondence and reprint requests to: Ida Sue Baron, Neuropsychology Research, Fairfax Neonatal Associates, 2720 Prosperity Avenue, Fairfax, VA 22031. E-mail: ida@isbaron.com
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Abstract

An observational study of neuropsychological outcomes at preschool age of tiered lowered oxygen (O2) saturation targets in extremely preterm neonates. We studied 111 three-year-olds born <28 weeks’ gestational age. Fifty-nine participants born in 2009–2010 during a time-limited quality improvement initiative each received three-tiered stratification of oxygen rates (83–93% until age 32 weeks, 85–95% until age 35 weeks, and 95% after age 35 weeks), the TieredO2 group. Comparisons were made with 52 participants born in 2007–2008 when pre-initiative saturation targets were non-tiered at 89–100%, the Non-tieredO2 group. Neuropsychological domains included general intellectual, executive, attention, language, visuoperceptual, visual-motor, and fine and gross motor functioning. Descriptive and inferential analyses were conducted. Group comparisons were not statistically significant. Descriptively, the TieredO2 group had better general intellectual, executive function, visual-motor, and motor performance and the Non-tieredO2 group had better language performance. Cohen’s d and confidence intervals around d were in similar direction and magnitude across measures. A large effect size was found for recall of digits-forward in participants born at 23 and 24 weeks’ gestation, d=0.99 and 1.46, respectively. Better TieredO2 outcomes in all domains except language suggests that the tiered oxygen saturation target method is not harmful and merits further investigation through further studies. Benefit in auditory attention appeared greatest in those born at 23 and 24 weeks. Participants in the tiered oxygen saturation group also had fewer ventilation days and a lower incidence of bronchopulmonary dysplasia, perhaps explanatory for these neuropsychological outcomes at age 3. (JINS, 2015, 21, 322–331)

Keywords

IntelligenceCognitivePretermNeurodevelopmentOxygen saturationBronchopulmonary dysplasiaDigit span
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 22 , Issue 3 , March 2016 , pp. 322 - 331
Copyright
Copyright © The International Neuropsychological Society 2015 

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