Oxygen therapy in preterm infants: past, present and future

Abstract

Oxygen is one of the most commonly used therapies in neonatology but the parameters of optimal oxygen for preterm infants have been debated for the past 50 years. The history of oxygen use in this population, as well as the results of clinical trials, have shown that liberal oxygen administration is associated with retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) whereas restrictive use results in increased mortality and neurodisability. Oxygen saturation (SpO₂) continuously measured by pulse oximetry is the bedside tool used to guide the fraction of inspired oxygen (FiO₂) delivered to preterm infants. Although evidence favours targeting predetermined SpO₂ ranges, achieving this goal consistently in clinical practice has been challenging due to intrinsic pulmonary immaturity, the need for respiratory support therapies and factors relating to the bedside caregivers’ ability to adjust FiO₂. This review article focuses on the difficulties of titrating oxygen therapy in this vulnerable group and provides recommendations for best practice based on up-to-date evidence.