Supplemental Oxygen Use

A Cautionary Tale About Supplemental Oxygen: The Albatross of Neonatal Medicine.  Silverman WA,  PEDIATRICS (February 2004);113: 394-396. [Full Text]  

In this eloquent commentary, Dr Silverman reviews the history of oxygen use in medicine, which dates back to the 1770s.  Oxygen use in the treatment of premature infants began in 1942, and the relationship between excess oxygen exposure and retinopathy of prematurity (originally called retrolental fibroplasia) was first suggested by Mary Crosse in 1951.  As to the optimal amount of oxygen supplementation for very low birth weight infants, Dr Silverman states:

“In the 1970s, transcutaneous O₂ electrodes arrived and were replaced in the 1980s by pulse oximeters, but these technologic advances provided a misleading sense of newly found accuracy. To put it bluntly, there has never been a shred of convincing evidence to guide limits for the rational use of supplemental oxygen in the care of extremely premature infants. For decades, the optimum range of oxygenation (to balance 4 competing risks: mortality, ROP blindness, chronic lung disease, and brain damage) was, and remains to this day, unknown. In the past few years, the findings in a number of studies have suggested that the long-accepted "physiologic" targets of O₂ saturation may be too high. There is now considerable interest in exploring lower levels, and the belated concerns recall explorations conducted in Sweden a half-century ago. It is encouraging to see that neonatal medicine is beginning to wake up after years of dogmatic slumber. If the plans for an international oxygen-targeting trial (Pulse Oximeter Saturation Trial for Prevention of ROP) are conducted in the near future, there is reason to hope that uncritical acceptance of authoritative opinion about the most frequently prescribed "drug" in the care of small neonates will come to an end, at long last.”

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