Liberal oxygen therapy elevates the demand for retinopathy treatment of prematurity in extremely preterm infants, while restricted oxygen therapy increases the risks of severe necrotizing enterocolitis and death. Safe and sound oxygen therapy must achieve the best possible trade-off between these risks and benefits in a local neonatal intensive care unit.

Transcutaneous oxygen probes and pulse oximetry are used clinically to monitor arterial oxygenation non-invasively. These were widely adopted even years before randomized trials determined the usage methods of these monitors. Trials of different oxygen saturation target ranges and the meta-analysis of the individual participant data have explained the balance between the benefits and risks of higher pulse oximeter saturations. Neonatal intensive care units with high risks of death and severe necrotizing enterocolitis will benefit more from higher target saturations than units with low risks of these outcomes. Similarly, neonatal intensive care units with a high risk of severe retinopathy will encounter more harm from higher target saturations than units with a low risk of severe retinopathy. 

Manual titration of supplemental oxygen is the current standard of care. It may be possible to improve compliance with the chosen oxygen saturation target range and pulse oximeter alarms through clearly defined titration protocols, training of bedside staff, appropriate workloads and work hours, and regular use of pulse oximeter histograms for audit and feedback.

Schmidt B, Kirpalani H. Safe and sound oxygen therapy for extremely preterm infants: a literature review. Pediatric Medicine. 2022;5:2617-5428. https://pm.amegroups.com/article/view/6765