In Reply We thank Lakshminrusimha and colleagues for their commentary on our work on the differential mortality experienced by small for gestational age infants in the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial. We are aware of the outstanding animal work on pulmonary hypertension performed by their group and believe that a similar mechanism may be operative in small for gestational age human infants. We agree with their belief that oxygen targeting may require an individualized approach based on risk factors to maximize the benefits and minimize harm to any single infant. The planned NEOPROM meta-analysis will offer additional insight into this finding. That analysis, together with a detailed analysis of intermittent hypoxia events in this cohort, will further inform practice.
Walsh MC, Di Fiore JM, Martin RJ. Interaction of Target Oxygen Saturation, Bronchopulmonary Dysplasia, and Pulmonary Hypertension in Small for Gestational Age Preterm Neonates—Reply. JAMA Pediatr. 2016;170(8):808. doi:10.1001/jamapediatrics.2016.0998