Get PJ Media on your Apple

PJM Lifestyle

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.

by
Theodore Dalrymple

Bio

May 18, 2013 - 7:00 am
<- Prev  Page 2 of 2   View as Single Page

The babies with the higher levels of oxygen saturation developed retinopathy of prematurity more frequently than those with lower (13.5 percent versus 10.6 percent), but nowadays the condition is treatable and does not usually lead to blindness.

By contrast, the other trial did not find any difference in the mortality rates of infants treated at higher and lower levels of oxygen saturation of the blood. The authors followed up the infants for longer — 18 months — and used a broader measure of outcome, namely a combination of death, gross motor disability, cognitive or language delay, severe hearing loss or bilateral blindness at the end of that period. Here, I confess, I found the results horrifying: in the high oxygen saturation group, 15.3 percent had died, while in the lower 16.6 percent had done so (a difference in rate so small that it was not statistically significant, that is to say it could have arisen by chance), while 34.4 percent of the higher and 35 percent of the lower saturation level babies suffered from at least one of the other conditions, namely gross motor disability, cognitive or language delay, severe hearing loss or bilateral blindness. Survival is thus often bought at a considerable cost: forty percent of survivors were handicapped or severely handicapped.

Naturally further research is required: it always is. The trials tested only two ranges of oxygen saturation, 85 to 89 percent and 91 to 95 percent. Other ranges were not investigated, as in theory they could be. Furthermore, a more prolonged follow-up of the infants might reveal differences between the groups that developed later in their lives.

What, then, is the neonatologist to conclude from these inconsistent results? He cannot, like Tybalt, just exclaim, “A curse on both your houses!” He has to make a choice.

One trial found no difference between the outcomes and the other a better outcome with a higher level of oxygen saturation. It seems to me, therefore, that he should choose the latter, because it might do good and has not been shown to do irreversible harm. But still one would prefer to have no inconsistency in the scientific results. However, in medicine inconsistency is the norm.

*******
ASK DR. DALRYMPLE…

Do you have a question about health and medicine you’d like to see addressed? Click below to contact PJ Lifestyle.

 Shutterstock images courtesy / Anneka / dream designs

<- Prev  Page 2 of 2   View as Single Page
Theodore Dalrymple, a physician, is a contributing editor of City Journal and the Dietrich Weismann Fellow at the Manhattan Institute. His new book is Second Opinion: A Doctor's Notes from the Inner City.

Comments are closed.

All Comments   (8)
All Comments   (8)
Sort: Newest Oldest Top Rated
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.
1 year ago
1 year 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.
1 year ago
1 year 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: http://clinicaltrials.gov/ct2/show/NCT01096784?term=premacure&rank=1

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.

Regards
1 year ago
1 year 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.
1 year ago
1 year 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.
1 year ago
1 year 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.
1 year ago
1 year 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.
1 year ago
1 year 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.
1 year ago
1 year ago Link To Comment
View All