Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation

Aim-To determine whether differing policies with regard to the control of o xygen saturation have any impact on the number of babies who develop retino pathy of prematurity and the number surviving with or without signs of cere bral palsy at one year. Methods-An examination of the case notes of all the 295 babies who survived infancy after delivery before 28 weeks gestation in the north of England i n 1990/994. Results-Babies given enough supplemental oxygen to maintain an oxygen satur ation of 88-98%, as measured by pulse oximetry, for at least the first 8 we eks of life developed retinopathy of prematurity severe enough to be treate d with cryotherapy four times as often as babies only given enough oxygen t o 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 diffe rence in the proportion who survived infancy (53% v 52%) or who later devel oped 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 Conclusions-Attempts to keep oxygen saturation at a normal " physiological " level may do more harm than good in babies of less than 28 weeks gestatio n.