Best oxygen levels for preterm infants remain unknown

This literature review found that the best oxygen levels to reduce ROP risk while optimizing preterm infant health and development remain unknown.

The authors reviewed major studies on oxygen use in preterm infants and the effects on the development of ROP.

They note how ROP first manifested as retrolental fibroplasia in 1942, when the technology to monitor or regulate oxygen did not exist and a fundus examination of preterm infants was not routinely performed. Supplemental, uncontrolled oxygen at birth has since been found to cause retrolental fibroplasia. Meanwhile, technological advances have made it possible to regulate oxygen and detect early forms of ROP.

More recently, researchers and clinicians have gained a better understanding of ROP, and major clinical trials have improved knowledge of supplemental therapeutic oxygen.

Studies have suggested that maintaining lower saturations in infants of 24 to 28 weeks’ gestational age reduces the incidence of severe ROP, as well as chronic lung disease. However, the best oxygen levels for reducing ROP, reducing pulmonary morbidity and increasing survival and cognitive development have not been determined.

The authors note that without more information, clinicians continue to have concerns about limiting oxygen. Many nurseries do not obtain routine blood gas measurements; therefore, assessments are made on the basis of SaO₂ (oxygen saturation) instead of PaO₂ (oxygen tension).

Recently, investigators from five multicenter trials convened to form a consensus. Results are not yet available, but there was a general conclusion to not target oxygen levels below 90 percent saturation.

Further research is needed to determine whether a combination of approaches may reduce morbidity while reducing the occurrence of severe ROP.