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SPA Newsletter.
A Cautionary Tale About Supplemental Oxygen: The Albatross of Neonatal MedicineSilverman, WA Pediatrics 2004;113:394-396Reviewed by: Thomas J. Mancuso, MD, FAAP This special article is a thorough, eminently readable review of the history of the use of supplemental oxygen in the treatment of respiratory distress in newborns and the morass of efforts to study whether retinopathy of prematurity (ROP) was a result of oxygen administration and later if it was possible to administer oxygen in a manner to avoid the development of ROP. Dr. Silverman describes the first trial of oxygen administration to newborns that failed to establish normal respirations in 1780! The modern era of oxygen administration began in the late 1900s following the observation (in 1942) that the erratic respiratory pattern seen in preterm infants could be converted to a regular pattern with the administration of supplemental oxygen. In 1948 the first cases of ROP (initially called RLF, retrolental fibroplasias) was described in Britain. In the next several years, poorly conducted trials of oxygen administration, reliance retrospective analysis the vigor with which proponents and opponents of supplemental oxygen administration voiced their opinions all contributed to public and medical uncertainty. Dr. Silverman nicely summarizes the situation now with the remark: "For decades, the optimum range of oxygenation (to balance four competing risks: mortality, ROP blindness, chronic lung disease and brain damage) remains, to this day, unknown." He concludes with the hope that the planned international trial, Pulse Oximetry Saturation Trial for Prevention of ROP, will resolve this uncertainly. Commentary This report is of interest to all who care for preterm infants. Whatever the relative risk of ROP in preterms given supplemental oxygen, it is very hard for me to argue against the use of 100% oxygen at induction and emergence of anesthesia. As a mentor of mine, one who described cases of ROP early on, once told me "the brain gets soft before the eyes get hard". Table of Contents
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