Gradual versus abrupt discontinuation of oxygen in preterm or low birth weight infants

Not enough evidence to show the best way to wean premature babies off oxygen supplementation. Babies born either prematurely (before 37 weeks) or with a low birthweight often have breathing problems and need extra oxygen. Appropriate oxygen levels are important as damage to the eyes or lungs can result if levels are too high or too low. The decision to stop giving oxygen gradually or abruptly can also affect the health of the baby. The review of trials found one trial that demonstrated that gradual rather than abrupt weaning from oxygen supplementation reduces the risk of eye damage but could not conclude which is the best method of weaning. More research is needed.

Authors' conclusions: 

The results of this systematic review provide additional evidence linking routine exposure to high ambient oxygen in the early neonatal period to the development of ROP in preterm/LBW infants. However, due to small numbers and historical oxygen monitoring techniques, they provide little assistance to clinicians with regard to the most appropriate method of oxygen weaning, gradual or abrupt, in modern neonatal care settings.

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Background: 

The issue of whether to abruptly or gradually discontinue supplemental oxygen is a contentious one. There have been mixed results in studies of both humans and animal models on the effects of either method of oxygen cessation on important infant outcomes.

Objectives: 

To determine the effect of gradual vs. abrupt discontinuation of supplemental oxygen on mortality, retinopathy of prematurity, lung function, growth and development in preterm or low birth weight infants.

Search strategy: 

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Oxford Database of Perinatal trials, MEDLINE, previous reviews including cross references, abstracts, conferences and symposia proceedings, expert informants, journal handsearching mainly in the English language. An additional literature search of the MEDLINE and CINAHL databases was conducted in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR).

Selection criteria: 

All trials utilising random or quasi-random patient allocation in which gradual weaning was compared with abrupt discontinuation of supplemental oxygen in preterm or low birth weight infants were eligible for inclusion.

Data collection and analysis: 

The methodological quality of the eligible trial 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. Results were compared and differences resolved as required. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group.

Main results: 

The results of the one small trial of 51 infants included in this systematic review indicate a significant reduction in vascular retrolental fibroplasia (i.e. severe ROP) for infants weaned gradually from high oxygen concentrations compared with abrupt discontinuation (RR 0.22, 95% CI 0.07-0.68). This finding was independent of the duration of oxygen therapy.

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