Optimal Oxygenation in Preterm Infants

ABSTRACT

In the past several decades, supplemental oxygen has been used more than any other medical product in preterm infants. Early trials suggested that restricting oxygen supplementation could reduce retinopathy of prematurity without any other consequences; however, when oxygen restriction was practiced widely, an increase in the neonatal mortality rate was observed. Subsequently, many studies have been reported oxygen toxicity and stress in the eye, brain, lungs and other organs. Both hypoxia and hyperoxia are harmful, requiring clinicians to maintain the oxygen level at an optimal middle range in premature infants to minimize the risks associated with either of the two extremes. Recently, the results of a multi-national, randomized, prospective, meta-analysis collaboration study shows low saturation targets (85-89%) until 36 weeks postmenstrual age are associated with a higher incidence of deaths and necrotizing enterocolitis, whereas higher saturation targets (91-95%) are associated with a higher incidence of retinopathy of prematurity in infants of <28 weeks' gestational age. The optimal oxygenation target level in preterm infants still remains unclear and randomized control trials are required for further investigation according to gestational age and conditions of preterm infants.