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Should Pre-Term Infants Receive Risky Oxygen Treatments?

Conflicting studies point to challenging results: doctors can save babies but at a higher risk of provoking the development of disabilities.

Theodore Dalrymple


May 18, 2013 - 7:00 am
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Simple scientific questions require simple scientific answers; doctors want unequivocal guidance to their practice so that they do not fumble in the dark. But it is easier to ask questions than to answer them, as two papers published in the same week in the New England Journal of Medicine and the Journal of the American Medical Association attest.

The question asked by the two papers was the optimum level of oxygenation in the blood of pre-term infants. In the past it was rather naively supposed that if oxygen were necessary, then more of it must be better; but premature infants who were exposed to high levels of oxygen developed a condition known as retinopathy of prematurity, often leaving them blind or severely impaired visually.

The two trials, one from Britain, Australia and New Zealand, and the other from the United States, Canada, Argentina, Finland, Germany and Israel, sought to establish whether a higher or lower level of oxygen saturation of the blood was better for infants born very prematurely. The results were different, if not quite diametrically opposed.

The first trial found that babies treated so that their blood oxygen saturation was higher had a lower death rate at 36 weeks than those treated so that their levels were lower. 15.9 percent in the high-saturation group died compared with 23.1 per cent in the lower. You would have to treat 14 babies with the high oxygen saturation to save life more than treating them at the lower level.

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All Comments   (8)
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It is, of course, a mark of erudition to quote from memory and slight variations are inevitable BUT that is a very famous line not only to misquote but also to misattribute who delivers it! I feel saddened by Dr Dalrymple's unusual lapse.
46 weeks ago
46 weeks ago Link To Comment
If the range of oxygen saturation varies from 85pc to 95pc, why not settle on 90pc for now? Apparently that level wasn't tested by either study, but common sense would say that shouldn't matter.
46 weeks ago
46 weeks ago Link To Comment
Dr. Darlymple,

You may find this research interesting from University of Gothenberg and Premacure. They are using rhIGF-I/rhIGFBP-3 complex replacement therapy to prevent complications of pre-term birth before they happen:

I'm not in the medical field and only know of this because for many years I've been invested in the company that owns the IP for the complex.

46 weeks ago
46 weeks ago Link To Comment
This reminds me of a question my mom asked my nurse just before my preemies were born. They were about to give me steroids to develop their luns, and she said she had read they could lower the babies' IQ's. The nurse replied "yes, studues have found this, but if the baby can't breathe the baby dies. Life is more important than a few IQ points. " So true. My tiny preemies are 9 now and test gifted, with no physical disabilities.
46 weeks ago
46 weeks ago Link To Comment
Perhaps animal experimentation would help answer this.

Reminds me that the reason we are so knowledgeable about many risks (e.g. radiation) is that we undertook the studies back in the forties and fifties to find out. Those who preen their own wisdom can only do so because some poor schmuck learned about it the hard way.
47 weeks ago
47 weeks ago Link To Comment
Craig, I sure would like to know what the basis of your assertion that the US government conducted studies on the effects of radiation exposure on animals in the mid-20th century. Yes, I'll google it.

Aside from some rather broad effects of large acute doses of X and gamma radiation, we still know very little about the effects of radiation on humans, and most of that knowledge comes from the studies done on the surviving populations of Hiroshima and Nagasaki. Particularly, we know very little about the somatic effects of chronic, low level exposures such as those received by nuclear plant workers and medical radiology workers.

My experience in this one area has been, that the regulators choose to err in what they believe is the conservative direction, but err they have. There may be some correlation between this aspect of medical science and that which attempts to save the prematurely born using gut checks and Kentucky windage.
46 weeks ago
46 weeks ago Link To Comment
By the way, most of the hit on teh google are made up of lefty outrage about tests involving humans, particularly those where the Army may have had troops dug in within the radius of above ground bomb test radiation burst. Tests on bunny rabbits, not so much.
46 weeks ago
46 weeks ago Link To Comment
Well, I was one of those oxygen-treated babies, so I have to say so far I'm pleased.

Of course I'm only 57.
48 weeks ago
48 weeks ago Link To Comment
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