Oxygen therapy in preterm infants: recommendations for practice
Sanoj Karayil Mohammad Ali, Nancy Mohammed, Nadia K. Qureshi, Samir Gupta
Abstract
Oxygen is one of the most commonly used therapies in neonatology but optimum oxygen saturations for preterm infants have been debated for the past 50 years. The history of oxygen use in this population and multiple clinical trials over the years have shown that liberal oxygen administration is associated with retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) whereas restrictive use results in increased mortality and neurodisability. Pulse oximetry (SpO 2 ) is a bedside tool to guide the fraction of inspired oxygen (FiO 2 ) delivered to the patient, and is the current standard of care for continuous monitoring. Although evidence favours targeting predetermined oxygen saturation ranges, achieving this goal consistently in clinical practice has been challenging due to intrinsic pulmonary immaturity, the need for respiratory support therapies and factors relating to the bedside caregivers ability to adjust FiO 2 . This review article focuses on the difficulties of titrating oxygen therapy in this vulnerable group and provides recommendations for the best practice based on up to date evidence.