Intervention Review

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

  1. Lisa M Askie1,*,
  2. David J Henderson-Smart2,
  3. Henry Ko3

Editorial Group: Cochrane Neonatal Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 14 AUG 2008

DOI: 10.1002/14651858.CD001077.pub2

How to Cite

Askie LM, Henderson-Smart DJ, Ko H. Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001077. DOI: 10.1002/14651858.CD001077.pub2.

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

  3. 3

    Southern Health, Centre for Clinical Effectiveness, Clayton, VIC, 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: 21 JAN 2009

SEARCH

 

Abstract

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

Background

While the use of supplemental oxygen has a long history in neonatal care, resulting in both significant health care benefits and harms, uncertainty remains as to the most appropriate range to target blood oxygen levels in preterm and low birth weight infants. Potential benefits of higher oxygen targeting may include more stable sleep patterns and improved long-term growth and development. However, there may be significant deleterious pulmonary effects and health service use implications resulting from such a policy.

Objectives

To determine whether targeting ambient oxygen concentration to achieve a lower vs. higher blood oxygen range, or administering restricted vs. liberal supplemental oxygen, effects 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. An additional literature search was conducted of the MEDLINE and CINAHL databases in order to locate any trials in addition to those provided by the Cochrane Controlled Trials Register (CENTRAL/CCTR). Search updated to week two July 2008.

Selection criteria

All trials in preterm or low birth weight infants utilising random or quasi-random patient allocation in which ambient oxygen concentrations were targeted to achieve a lower vs. higher blood oxygen range, or restricted vs. liberal oxygen was administered were eligible for inclusion.

Data collection and analysis

The methodological quality of the eligible trials was assessed independently by each review author for the degree of selection, performance, attrition and detection bias. Data were extracted and reviewed independently by the each author. Data analysis was conducted according to the standards of the Cochrane Neonatal Review Group.

Main results

In the meta-analysis of the five trials included in this review, the restriction of oxygen significantly reduced the incidence and severity of retinopathy of prematurity without unduly increasing death rates The one prospective, multicenter, double-blind, randomized trial investigating lower vs. higher blood oxygen levels from 32 weeks postmenstrual age showed no significant differences in the rates of ROP, mortality or growth and development between the two groups. However, this study did show increased rates of chronic lung disease and home oxygen use.

Authors' conclusions

The results of this systematic review confirm that (the now historical) policy of unrestricted, unmonitored oxygen therapy has potential harms without clear benefits. However, the question of what is the optimal target range for maintaining blood oxygen levels in preterm/LBW infants was not answered by the data available for inclusion in this review.

 

Plain language summary

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

Restricted versus liberal oxygen exposure for preventing morbidity and mortality in preterm or low birth weight infants

Restricting oxygen supplementation significantly reduces the rate and severity of vision problems (retinopathy) in premature and low birth weight babies. Babies born either prematurely (before 37 weeks) or with a low birth weight often have breathing problems and need extra oxygen. Oxygen supplementation has provided many benefits for these babies but can cause damage to the eyes (retinopathy) and lungs. The review of trials found that unrestricted oxygen supplementation has these potential adverse effects without any clear benefits. Restricted oxygen significantly reduces these risks. More research is needed to find the best level of oxygen supplementation.

 

摘要

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

背景

對於早產或是出生時體重過輕的嬰兒來說,為了預防死亡率與罹病率,而在氧氣供應量方面,將有限制的供應與自由開放的供應來進行比較

在新生兒照護方面,給予氧氣的使用已經有很久的歷史了,這種治療在健康照護方面同時會帶來明顯的好處與危害,但是在早產與出生時體重過輕的嬰兒,最合適之血中氧氣的理想標準的範圍仍尚未確定。若是氧氣濃度設定為比較高的時候,可會帶來某些好處,包括了更為穩定的睡眠狀況,以及長期的生長與發展都可以獲得改善。然而,對於肺部方面卻有著明顯的不良影響,以及因為這種方法所導致在衛生服務應用方面的影響。

目標

在早產或是出生時體重過輕的嬰兒身上,針對是否以常壓下的氧氣濃度為標準來達到較低的血中氧氣範圍跟達到較高的血中氧氣範圍來進行比較,或是在給予氧氣補充方面,將有限制的給予與自由開放的給予進行比較,確認這些方式是否會影響到死亡的數目、過早出生所造成的視網膜病變、肺部功能,以及生長或發育。

搜尋策略

採用 Neonatal Review Group 標準搜尋策略,並額外搜尋MEDLINE和 CINAHL資料庫以找出Cochrane Controlled Trials Register (CENTRAL/CCTR) 當中沒有的試驗。搜尋更新到2008年7月第2周。

選擇標準

這些早產或是出生時體重過輕的嬰兒,都使用了隨機或是半隨機的病患分配方法,其中還設定了常壓的氧氣濃度來作為標準,以達到較低的血中氧氣範圍,並且與較高的血中氧氣範圍進行比較。或是在給予氧氣方面,將有限制的給予與自由開放的給予進行比較。這些的試驗都可符合收集的標準。

資料收集與分析

每位審稿的作者都針對了選擇的等級、表現狀況、消耗情況,以及偵測時的偏差等方面,獨立地對於合格試驗當中所使用之方法,來評估它們的品質。每位作者都獨立地進行了資料擷取與審查的工作。有關於資料方面的分析,都是根據 Cochrane Neonatal Review Group的標準所完成的。

主要結論

在本篇回顧當中,針對裡面所收集的5項試驗所完成的統合分析中顯示,若是限制了氧氣,可以明顯地降低因為過早出生時所造成之視網膜病變的發生率與嚴重性,而且不會大幅提高死亡的比例。有1項兼具前瞻性的、多中心的、雙盲式的、隨機試驗顯示,從月經停止後32週的年齡開始,使用較低的血中氧氣濃度比起使用較高的血中氧氣濃度時,針對ROP的比率、死亡數目,或是生長與發育等方面,都並沒有明顯的差異。然而,這份研究卻顯示出慢性肺部疾病與家中的氧氣使用方面,比率都提升了。

作者結論

在使用非受限性的、非監控性的氧氣療法方面,根據本篇系統性回顧的各項結果,確認(目前而言屬於歷史的觀點)了此項策略會帶來潛在的危機,而且沒有辦法提供明確的優點。然而,就本篇回顧中所收集的內容而言,關於讓早產/出生時體重過輕的嬰兒之血中的氧氣濃度應該維持在什麼樣最佳的範圍,沒有辦法以我們手邊可取得的資料來進行回答。

翻譯人

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

總結

將補供氧氣的供應量限制住,對於過早出生及出生時體重過輕的嬰兒來說,可以明顯地降低發生視力問題(視網膜病變)的比率與嚴重性。嬰兒在出生的時候,不論是過早出生(早於37週)或是出生時體重過輕,通常都會有呼吸方面的問題,並且需要額外補充氧氣。對於這些嬰兒來說,氧氣的補充可以帶來許多的助益,但是也可能會引發眼睛(視網膜病變)與肺部方面的損傷。本篇試驗的回顧發現,若是對於氧氣的補充不加限制的話,就會有這些潛在的不良影響,而且不具有任何明確的優點。對氧氣的補充進行限制,將可以明顯地減少這些風險。還需要有更多的研究,來探討氧氣補充時所應該要達到的最佳濃度。