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Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight
L M Askie1, D J Henderson-Smart
1NSW Centre for Perinatal Health Services Research, Building DO2, University of Sydney, NSW, Australia., 2006. laskie@mail.usyd.edu.au
Insights
Restricting oxygen for preterm infants significantly reduced retinopathy of prematurity. However, optimal blood oxygen targets for these vulnerable infants remain unclear, with limited data on other outcomes.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Ophthalmology
Background:
- Preterm and low birth weight infants require careful oxygen management.
- Current oxygen administration practices vary, necessitating evidence-based guidelines.
Purpose of the Study:
- To evaluate the impact of targeted oxygen concentrations on mortality, retinopathy of prematurity, lung function, growth, and development in preterm/low birth weight infants.
- To compare restricted versus liberal supplemental oxygen administration strategies.
Main Methods:
- A systematic review and meta-analysis of randomized controlled trials.
- Searches conducted across major databases including MEDLINE, EMBASE, and CINAHL.
- Methodological quality assessment and independent data extraction by authors.
Main Results:
- Oxygen restriction significantly reduced the incidence and severity of retinopathy of prematurity without increasing mortality.
- One trial showed no effect on mortality for lower vs. higher PaO2 targets but lacked detailed outcome reporting.
- Limited data exist on the effects of oxygen policies on chronic lung disease, neurodevelopment, and long-term growth.
Conclusions:
- Unrestricted, unmonitored oxygen therapy in preterm infants carries potential harms without clear benefits.
- The optimal target range for blood oxygen levels in preterm/low birth weight infants requires further investigation.
Background:
This section is under preparation and will be included in the next issue.
Objectives:
In preterm or low birth weight infants, does targeting ambient oxygen concentration to achieve a lower versus higher blood oxygen range, or administering restricted versus liberal supplemental oxygen, influence mortality, retinopathy of prematurity, lung function, growth or development?
Search Strategy:
The standard search strategy of the Neonatal Review Group was used. An additional literature search was conducted of the MEDLINE, EMBASE, and CINAHL databases in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR).
Selection Criteria:
All trials in preterm or low birth weight infants utilising random or quasi-random patient allocation, in which ambient oxygen concentrations were targeted to achieve a lower versus higher blood oxygen range, or restricted versus liberal oxygen was administered, were eligible for inclusion.
Data Collection And Analysis:
The methodological quality of the eligible trials was assessed independently by each author for the degree selection, performance, attrition and detection bias. Data were extracted and reviewed independently by the each author. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group.
Main Results:
The restriction of oxygen significantly reduced the incidence and severity of retinopathy of prematurity without unduly increasing death rates in the meta-analysis of the five trials included in this review. The one trial that specifically addressed the question of lower versus higher PaO2 found no effect on death, but did not report (in sufficient detail to warrant inclusion) the effect of this intervention on eye or other outcomes. The effects of either of these oxygen administration policies on other clinically meaningful outcomes including chronic lung disease and long term growth, neurodevelopment, lung or visual function were not reported in any of the available trials.
Reviewer'S Conclusions:
The results of this meta-analysis confirm the commonly held view of today's clinicians that a policy of unrestricted, unmonitored oxygen therapy has potential harms, without clear benefits. However, the question of what is the optimal target range for maintaining blood oxygen levels in preterm/LBW infants was not answered by the data available for inclusion in this review.