Impact of Oxygen Saturation Targets and Oxygen Therapy during the Transport of Neonates with Clinically Suspected Congenital Heart Disease
Bibliographic record
Abstract
BACKGROUND: Although guidelines for mechanical ventilation, cardiovascular support and intravenous prostaglandin are well established, there is a lack of consensus regarding SpO(2) targets and safety of oxygen administration during transport of neonates with suspected congenital heart disease (CHD). In many centers, an SpO(2) range of 75-85% is targeted but there is no published evidence of the clinical consequences of this approach. OBJECTIVE: To determine the effect of average SpO(2) range and oxygen administration during neonatal transport on clinical markers of cardiovascular instability. METHODS: A retrospective study was conducted on neonates with suspected CHD who presented at community hospitals. Based on average SpO(2) during transport, neonates were categorized into three distinct groups: group I (SpO(2) <75%), group II (SpO(2) 75-85%), group III (SpO(2) >85%). The severity and proportion of neonates with hypoxemia, metabolic and lactic acidosis on arrival at level III NICU were compared. A comparison was also made between oxygen requirement and indicators of cardiorespiratory instability. RESULTS: Seventy-five neonates were studied and 14 (19%), 38 (50%) and 23 (31%) neonates were allocated to groups I, II and III, respectively. Therapeutic interventions during the transport stabilization process included oxygen (n = 53, 71%), mechanical ventilation (n = 56, 75%) and prostaglandin E1 (n = 63, 84%). The severity or proportion of neonates with hypoxemia, elevated lactate or metabolic acidosis was similar between the groups. Neonates receiving an oxygen requirement of FiO(2) >70% had lower arterial SpO(2) on arrival. A provisional diagnosis of CHD and/or PPHN (p = 0.01) and neonates receiving inotropes (p = 0.005) were independent risk factors for cardiovascular instability. CONCLUSION: If congenital heart disease is strongly suspected oxygen should be cautiously weaned to maintain a minimum SpO(2) >75%. Neonates receiving >70% oxygen are at greatest risk of metabolic acidosis or critical hypoxemia and may benefit from expedited transfer to a cardiac center.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".