Babies born 13 to 16 weeks early often have
trouble breathing on their own because their lungs
are not fully developed.
So it's common practice to give them oxygen to
help them breathe.
There isn't a lot of research to determine
exactly how much oxygen they should get,
or the best method to provide it to them.
We know that if a baby's blood oxygen levels are
too low, they can develop brain or other organ
damage, or even die.
On the other hand, we know that some babies
given 100 percent oxygen are at high risk for a
condition known as retinopathy of prematurity.
Retinopathy of prematurity can cause vision
impairment or blindness.
So, lower oxygen levels might help prevent
retinopathy of prematurity.
Over the past 30-40 years, many hospitals have
started using a newer technique for delivering
oxygen to preemies.
Traditionally, preterm infants are given oxygen
through a ventilator.
The ventilator tube is placed into the infant's
wind pipe and pulses air into the lungs.
The ventilator tube can also be used to administer
surfactant into the lungs.
That's a sticky substance that helps to keep the
tiny air sacs open.
In recent years, some hospitals have supplied
oxygen through a CPAP device.
CPAP, or C-P-A-P, stands for continuous positive
airway pressure.
It's used to treat adults with sleep apnea.
With CPAP, a fitting is placed into the babies
nostrils, and gently pumps air into the lungs.
It's usually used without surfactant.
CPAP has not been directly compared to
surfactant prior to the current study.
Researchers in the NICHD Neonatal Research
Network observed more than 1,300 infants
born at 20 sites.
These infants were very premature-born between
the 24th and 27th week of pregnancy.
They weighed only one to two pounds on average,
and many needed respiratory therapy.
For one arm of the study, we compared two different
oxygen saturation targets:
85-89 percent versus 91-95 percent.
The other part of the study compared the
methods used to provide oxygen to the infants:
ventilator with surfactant or the CPAP device.
The first study found that the different oxygen levels
had different effects on survival and
retinopathy of prematurity.
More of the infants in the low oxygen level group
died than did the infants in the higher level group:
19.9 percent versus 16.2 percent.
However, fewer of the infants on the lower
oxygen level developed severe
retinopathy of prematurity:
8.6 percent versus 17.9 percent.
It's important to stress that two-thirds of the
cases of severe retinopathy
improve without treatment.
Of the remaining one-third, these infants can go
on to develop severe visual impairment
or become legally blind.
Some children with milder degrees of
retinopathy of prematurity do develop eye and
vision problems.
In the second study, we found that infants on
CPAP did as well as the infants on the ventilator
surfactant group.
They were more likely to have survived and did not
require breathing therapy a week after being born.
The CPAP infants were less likely to need steroid
treatment for their lungs and spent less time overall
on ventilators.
The earliest preterm infants in the study,
born at 24 to 25 weeks gestation, were less likely
to die if they had received CPAP initially than had
they been on a ventilator.
Oxygen saturation levels are extremely important
for preterm infant survival.
Higher oxygen levels improve survival, but also
increase the chances of retinopathy of prematurity.
We also want to emphasize that CPAP
appears to be an appropriate first treatment
for preterm newborns.
CPAP appears to be just as effective as ventilator
therapy especially for these very tiny,
very preterm infants and is associated with
fewer complications.