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Editor—The observations of Tinet al 1 have led them to suggest that babies may have better overall outcomes when unit policies aim at oxygen levels of 70–90%, much lower than current practice in most NICUs. While I would support their call for further well designed research into this question, I have major concerns that this concept of beneficial hypoxia might creep into clinical practice, and even be extended to the older survivors. The authors are clearly aware of the limitations of their study. There are obviously many possible alternative reasons for the differences in outcome between the nurseries; table 2 of the study suggests widely divergent policies on a number of issues apart from oximetry levels. There are no data supplied regarding the actual oximetry levels maintained in the nurseries, which makes conclusions about the safety of a saturation of 70% rather speculative.
My main concern is the potential risk to older babies with chronic lung disease who might once again be sunjected to chronic hypoxia. Since the more widespread acceptance that babies with chronic lung disease require similar oxygen levels to their more fortunate brethren we have largely abolished the high first year mortality in these babies, and the pulmonary hypertension which was previously seen. One observational study of differing oximetry levels within a single unit confirmed the high risk of even mild chronic hypoxia in this group of infants,2 showing a high risk of apparently life threatening events in the hypoxic infants.
While there is continued uncertainty about the optimum oximetry levels in the early life of a preterm baby, there is no justification for maintaining subnormal levels of oxygen in babies beyond 34–36 weeks of age with chronic lung disease, and I trust that this paper will not encourage such practice.