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Meta-Analysis
. 2009 Jan 21;2009(1):CD001077.
doi: 10.1002/14651858.CD001077.pub2.

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

Lisa M Askie  1 , David J Henderson-Smart, Henry Ko
Affiliations
Meta-Analysis

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

Lisa M Askie et al. Cochrane Database Syst Rev. .

Abstract

Background: While the use of supplemental oxygen has a long history in neonatal care, resulting in both significant health care benefits and harms, uncertainty remains as to the most appropriate range to target blood oxygen levels in preterm and low birth weight infants. Potential benefits of higher oxygen targeting may include more stable sleep patterns and improved long-term growth and development. However, there may be significant deleterious pulmonary effects and health service use implications resulting from such a policy.

Objectives: To determine whether targeting ambient oxygen concentration to achieve a lower vs. higher blood oxygen range, or administering restricted vs. liberal supplemental oxygen, effects mortality, retinopathy of prematurity, lung function, growth or development in preterm or low birth weight infants.

Search strategy: The standard search strategy of the Neonatal Review Group was used. An additional literature search was conducted of the MEDLINE and CINAHL databases in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR). Search updated to week two July 2008.

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 vs. higher blood oxygen range, or restricted vs. liberal oxygen was administered were eligible for inclusion.

Data collection and analysis: The methodological quality of the eligible trials was assessed independently by each review author for the degree of 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: In the meta-analysis of the five trials included in this review, the restriction of oxygen significantly reduced the incidence and severity of retinopathy of prematurity without unduly increasing death rates The one prospective, multicenter, double-blind, randomized trial investigating lower vs. higher blood oxygen levels from 32 weeks postmenstrual age showed no significant differences in the rates of ROP, mortality or growth and development between the two groups. However, this study did show increased rates of chronic lung disease and home oxygen use.

Authors' conclusions: The results of this systematic review confirm that (the now historical) 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.

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Conflict of interest statement

Askie and Henderson‐Smart have conducted and published a randomized, controlled trial of the effect of higher vs. standard oxygen saturation targeting on long‐term growth and development of preterm infants.

Figures

1.1
1.1. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 1 Death (any).
1.2
1.2. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 2 Cicatricial RLF (any grade) in survivors.
1.3
1.3. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 3 Vascular RLF (any stage) in survivors.
1.4
1.4. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 4 Vascular RLF (severe stages) in survivors.
1.5
1.5. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 5 Cicatricial RLF (severe grades) in survivors.
1.6
1.6. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 6 Death or vascular (RLF (any stage).
1.7
1.7. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 7 Death or cicatricial RLF (any grade).
1.8
1.8. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 8 Cicatricial RLF (severe grades) in survivors (excluding Patz 1954).
1.9
1.9. Analysis
Comparison 1 Restricted versus liberal oxygen therapy (all preterm/LBW infants) in early neonatal period, Outcome 9 Vascular RLF (any stage) in survivors (excluding Patz 1954).
2.1
2.1. Analysis
Comparison 2 Restricted versus liberal oxygen therapy (BW<1000g) in early neonatal period, Outcome 1 Cicatricial RLF (severe grades) in survivors.
3.1
3.1. Analysis
Comparison 3 Lower versus higher blood oxygen levels (all preterm/LBW infants) in early neonatal period, Outcome 1 Death (any).
4.1
4.1. Analysis
Comparison 4 Lower versus higher blood oxygen levels (BW<1250g) in early neonatal period, Outcome 1 Death (any).
5.1
5.1. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 1 Death.
5.2
5.2. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 2 ROP (any stage) in survivors.
5.3
5.3. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 3 ROP >Stage 2 in survivors.
5.4
5.4. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 4 ROP Stage 4 or 5 or blindness in survivors.
5.5
5.5. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 5 Death or ROP >Stage 2.
5.6
5.6. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 6 Death or ROP Stage 4 or 5 or blindness.
5.7
5.7. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 7 Dependence on supplemental oxygen at 36 weeks of postmenstrual age.
5.8
5.8. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 8 Postnatal corticosteroids.
5.9
5.9. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 9 Diuretics for chronic lung disease.
5.10
5.10. Analysis
Comparison 5 Lower versus higher blood oxygen levels (all preterm/LBW infants) in later neonatal period, Outcome 10 Major developmental abnormality at 12 months corrected age.
6.1
6.1. Analysis
Comparison 6 Lower versus higher blood oxygen levels (<28 weeks GA) in later neonatal period, Outcome 1 ROP Stage 3 or 4.
6.2
6.2. Analysis
Comparison 6 Lower versus higher blood oxygen levels (<28 weeks GA) in later neonatal period, Outcome 2 Blindness.
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References

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MeSH terms