Related Experiment Videos
Oxygen monitoring in preterm babies: too high, too low?
Win Tin1, Sue Walker, Camilla Lacamp
1Department of Paediatrics and Neonatal Medicine, The James Cook University Hospital, Middlesbrough, UK. wim.tin@stees.nhs.uk
Insights
Excess oxygen therapy may cause retinal blindness in preterm infants. Further research is needed to optimize oxygen delivery for premature babies, especially those under 28 weeks gestation.
Area of Science:
- Neonatal care
- Ophthalmology
- Clinical trials
Background:
- Randomized controlled trials (RCTs) have historically guided neonatal oxygen therapy.
- Early studies linked excess oxygen to retinopathy of prematurity (ROP).
Observation:
- A 1952 trial of 65 preterm infants questioned oxygen therapy's safety.
- A subsequent 1956 trial involving 212 infants confirmed these findings.
- Recent trials show avoiding hypoxemia (low oxygen saturation) in older infants does not improve outcomes.
Findings:
- Optimal oxygen saturation levels for preterm infants remain undetermined after 50 years.
- Current evidence suggests avoiding subclinical hypoxemia in infants over one month old yields no developmental benefits.
Implications:
- There is a critical need to re-evaluate oxygen administration protocols for preterm infants.
- Further research, utilizing RCTs, is essential to establish safe and effective oxygen thresholds.
- Optimizing oxygen delivery is crucial for reducing risks of chronic lung disease and permanent retinal damage in vulnerable preterm infants, particularly those born before 28 weeks gestation.
Abstract:
A small randomised trial in 1952 showed that excess oxygen use might well be causing a major epidemic of retinal blindness in preterm babies. That single study of just 65 babies was enough to throw doubt on a longstanding treatment strategy of oxygen therapy and highlighted just how powerful a tool the randomised controlled trial could be. Confirmatory evidence from a co-operative trial 4 years later involving 212 babies banished all residual doubt and we should reproach ourselves that we have still not learnt after 50 years how to optimise oxygen delivery to the preterm baby, making further use of this powerful research tool. Two well-conducted trials have recently shown that avoiding subclinical hypoxaemia (a fractional SaO(2) of less than 92%) in babies more than a month old does nothing to improve later growth or development. It is now time the same question was asked of babies less than a month old. This is particularly important in babies of less than 28 weeks' gestation, who currently remain at serious risk of chronic lung disease and permanent retinal damage.