Intervention Review

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

  1. Lisa M Askie1,*,
  2. David J Henderson-Smart2

Editorial Group: Cochrane Neonatal Group

Published Online: 23 OCT 2001

Assessed as up-to-date: 24 AUG 2008

DOI: 10.1002/14651858.CD001076


How to Cite

Askie LM, Henderson-Smart DJ. Early versus late discontinuation of oxygen in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD001076. DOI: 10.1002/14651858.CD001076.

Author Information

  1. 1

    University of Sydney, NHMRC Clinical Trials Centre, Camperdown, NSW, Australia

  2. 2

    Queen Elizabeth II Research Institute, NSW Centre for Perinatal Health Services Research, Sydney, NSW, Australia

*Lisa M Askie, NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW, 2050, Australia. laskie@ctc.usyd.edu.au.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 23 OCT 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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 methods

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).

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

比較早期和晚期停止氧氣使用對早產兒或低體重嬰兒的影響.

一般認為不論供氧濃度,桓運週數及/或出生體重,供氧期間長短本身對早產兒視網膜病變的嚴重程度有影響.擔心供氧時間過長會有不良影響,因此許多醫師嘗試讓嬰兒盡早停用氧氣.但最近貓科動物研究指出:於早產兒視網膜病變恢復期持續供氧有利於視覺發展.供氧期間長短對早產兒或出身體重較輕嬰兒的長期發育和發展仍不明.

目標

對早產兒或低體重兒,較早或較晚停止供氧,是否會影響其死亡率,視網膜病變,肺功能,生長或發展?

搜尋策略

採Neonatal Review Group的標準搜尋策略.搜尋包含the Oxford Database of Perinatal Trials和MEDLINE.之前回顧包含交互文獻查詢,摘要,學會或會議,專家討論和手動搜尋英文期刊.另外搜尋MEDLINE和CINAHL,以找出是否有Cochrane Controlled Trials Register (CENTRAL/CCTR)之外的試驗

選擇標準

考慮所有隨機或半隨機分配病患的試驗,比較對早產兒或低體重兒較早或較晚停止供氧.

資料收集與分析

由各回顧作者獨立評估一項合格試驗在選擇偏差,表現偏差,分配和檢驗偏差方面的方法學品質.擷取並由各作者獨立檢視臨床結果變項,變項包含:死亡率,視網膜病變,肺功能,長期生長或發展.比較各作者擷取的結果並解決歧異.依照Cochrane Neonatal Review Group.的標準分析資料

主要結論

只有一個合格試驗,共有99位出生體重低於1650克的嬰兒,所有嬰兒或體重低於1000克的嬰兒,其新生兒死亡率或任何嚴重度的水晶體後纖維組織增生都沒有顯著差異.其他可推斷為臨床有意義的量測都不夠完備,或追蹤率不佳無法納入分析(早期死亡,慢性肺病和長期生長發展,肺和視覺功能).

作者結論

本系統性回顧的結果並沒有提供強烈證據證明提早停止供氧對早產或出生體重不足的嬰兒有害或有利.將來的研究應研究新生兒早期和晚期,最合適的氧合濃度,而不是研究是否該提早或延後停止供氧.

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

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

總結

沒有提供強烈證據證明提早停止供氧對早產 或出生體重不足的嬰兒有害或有利.早產(早於37週)或出生體重不足的嬰兒常有呼吸器官的問題且需要供氧.供氧提供許多好處給這些嬰兒,能準確量測氧氣量可幫助降低副作用.正確停止供氧的時間未知,但通常依照嬰兒的年齡,體重增加量和呼吸能力調整.本回顧未能從試驗中找出足夠證據證明提早停止供氧對早產或出生體重不足的嬰兒有害或有利.需要更多試驗.