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a Department of
Paediatrics, South Cleveland Hospital, Middlesbrough TS4 3BW, UK, b Royal Victoria Infirmary,
Newcastle upon Tyne NE1 4LP, UK
Correspondence to: Dr Tin wtin{at}freenet.co.uk
Accepted 11 November 2000
AIM
To determine
whether differing policies with regard to the control of oxygen
saturation have any impact on the number of babies who develop
retinopathy of prematurity and the number surviving with or without
signs of cerebral palsy at one year.
METHODSAn examination
of the case notes of all the 295 babies who survived infancy after
delivery before 28 weeks gestation in the north of England in
1990-1994.
RESULTSBabies given
enough supplemental oxygen to maintain an oxygen saturation of
88-98%, as measured by pulse oximetry, for at least the first 8 weeks
of life developed retinopathy of prematurity severe enough to be
treated with cryotherapy four times as often as babies only given
enough oxygen to maintain an oxygen saturation of 70-90% (27.2%
v 6.2%). Surviving babies were also
ventilated longer (31.4 v 13.9 days), more
likely to be in oxygen at a postmenstrual age of 36 weeks (46%
v 18 %), and more likely to have a weight below the third centile at discharge (45% v
17%). There was no difference in the proportion who survived infancy
(53% v 52%) or who later developed
cerebral palsy (17% v 15%). The lowest incidence of retinopathy in the study was associated with a policy that
made little use of arterial lines.
CONCLUSIONSAttempts
to keep oxygen saturation at a normal "physiological" level may do
more harm than good in babies of less than 28 weeks gestation.
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