Early versus late discontinuation of oxygen in preterm or low birth weight infants

Not enough evidence to show the benefits or adverse effects of early oxygen weaning in preterm or low birthweight babies. Babies born either prematurely (before 37 weeks) or with a low birthweight often have breathing problems and need extra oxygen. Oxygen supplementation has provided many benefits for these babies and the ability to measure oxygen levels accurately can help reduce adverse effects. The correct time to wean babies off oxygen supplementation has been unclear but is usually measured by their age, weight gain and breathing ability. The review did not find enough evidence from trials to show the benefits or adverse effects of early oxygen weaning in preterm or low birth weight babies. More research is needed.

Authors' conclusions: 

The results of this systematic review do not provide strong evidence for either the benefits or harms of early oxygen weaning in preterm/LBW infants. Future research should be directed toward addressing the question of what are the most appropriate target levels of oxygenation, in both the early and late neonatal periods, rather than whether oxygen should be weaned early or late.

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Background: 

It has been hypothesized that the duration of supplemental oxygen administration, independent of the oxygen concentration, gestational age and/or birth weight, is influential in the development of severe retinopathy of prematurity (ROP). Concern regarding the possible deleterious effects of prolonged oxygen supplementation has lead many clinicians to wean infants from oxygen therapy as early as possible. However, recent work in feline models has suggested that visual outcomes may be improved by continuing oxygen supplementation during the recovery phase of ROP. The effect of duration of oxygen supplementation on the long-term growth and development of preterm or low birth weight infants remains unclear.

Objectives: 

To determine the effect of early versus late weaning from supplementary oxygen on 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. 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 early weaning was compared with late discontinuation of supplemental oxygen in preterm or low birth weight infants were eligible for inclusion.

Data collection and analysis: 

The degree of selection, performance, attrition and detection bias was assessed independently by each review author. Data regarding clinical outcomes including mortality, retinopathy of prematurity, and long-term growth and development were extracted and reviewed independently by each review 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: 

In the single eligible trial of 99 infants with birth weights less than 1650 g, there were no significant differences in neonatal death rates or retrolental fibroplasia (any grade or severe) for all infants, or among infants with birth weights of less than 1000 g. No other outcome measures specified a priori as clinically meaningful were reported in enough detail or with satisfactory follow-up rates to include in the analysis (early death, chronic lung disease, long-term growth, development, lung or visual function).

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