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

  • Review
  • Intervention

Authors


Abstract

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 methods

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.

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.

摘要

背景

漸進或驟進方式停止早產兒或低體重兒氧氣供應的比較

是否應突然或漸進地停止氧氣的供應一直是受爭議的話題。不論用何種方式停止氧氣的供應,在人類或動物實驗對新生兒重要的預後項目,皆顯示混雜的結果。

目標

探索在早產兒或低體重兒,漸進或驟進地停止氧氣的供應會不會影響其死亡率、早產兒視網膜病變、肺功能、生長或發育?

搜尋策略

採用Cochrane Neonatal Review Group的標準研究政策。包括Oxford Database的週產期相關報告、MEDLINE、之前的評論包含相關參考資料、摘要、會議和討論會的記錄、專家意見,和主要為以英文寫作之醫學期刊的逐一查詢。另外還使用MEDLINE和CINAHL資料庫做文章搜尋,以找出Cochrane Controlled Trials Register (CENTRAL/CCTR) 所能提供外的任何臨床試驗。

選擇標準

所有使用隨機或近似隨機抽樣方式分配病患,比較漸進或驟進地停止對早產兒或低體重兒供應氧氣的臨床試驗,都可收入。

資料收集與分析

收入的各個研究之品質,是由各作者獨自依個案挑選、臨床表現、耗損率和偵測偏差的程度來評估。資料是由各作者自行擷取和檢閱,結果再拿來比較和統合。資料分析是根據Cochrane Neonatal Review Group的標準來處理。

主要結論

在系統性的整理發現在一個包含51位嬰兒的小型試驗中,用漸進方式對給予高濃度氧氣的嬰兒逐漸停止氧氣供應是要比驟進式停止,在血管性晶狀體後纖維增生 (嚴重早產兒視網膜病變) 的發生上有顯著的減少 (RR 0.22, 95% CI 0.07 – 0.68) 。此結果與氧氣給予的時間長短不相關。

作者結論

此系統回顧的結果提供額外證據顯示在新生兒初期,常規使用高濃度氧氣與早產兒/低體重兒視網膜病變的產生有聯結。然而,因為個案數少和氧氣監測技術,此結果在現代新生兒照護上對臨床醫師如何以最適當的方式停止氧氣的供應,無論是採漸進或驟進地方式,僅能提供少許的幫助。

翻譯人

本摘要由馬偕醫院謝雨潤翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

並沒有足夠的證據有最好的方式去停止供給氧氣給早產兒。不論是早產 (妊娠週數小於37週) 或是低體重兒常有呼吸的問題及需要額外的氧氣。精準的氧氣濃度是重要的,若是不當的氧氣值將對眼睛和肺部造成傷害。漸進或突然的停止給予氧氣也會影響新生兒的健康。此篇回顧發現漸漸的停止給予氧氣供給比突然的方式能減少對眼睛的傷害,但還是無法下定論說何種方式最佳。需要以後更多的研究。

Plain language summary

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.

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