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June 5, 2018

Optimizing Oxygen Saturation Targets in Extremely Preterm Infants

Author Affiliations
  • 1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
JAMA. 2018;319(21):2173-2174. doi:10.1001/jama.2018.5724

The safest and most effective use of supplemental oxygen in preterm infants has been the subject of ongoing research and debate for several decades. In the 1940s, before continuous noninvasive estimates of arterial oxygen saturation as measured by pulse oximetry (Spo2) were possible, premature newborns were routinely exposed to unrestricted oxygen therapy to stimulate respiratory drive. In 1951, Campbell1 suggested an association between this practice and the development of retrolental fibroplasia (ie, retinopathy of prematurity [ROP]). During the decades that followed, restriction of supplemental oxygen and avoidance of hyperoxia became the standard in most neonatal intensive care units. This practice was further supported when data from 2 large randomized clinical trials (RCTs),2,3 the Supplemental Therapeutic Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP) and Benefits of Oxygen Saturation Targeting (BOOST), revealed that use of higher Spo2 ranges (96%-99% vs 89%-94% in STOP-ROP and 95%-98% vs 91%-94% in BOOST) in preterm neonates significantly increased their risk of severe pulmonary morbidity without substantial benefit.