Optimal oxygen saturation for preterm babies. Do we really know?

Oxygen is the most commonly used 'drug' in neonatal units as an integral part of respiratory support. It has also been known for half of the century that it is easy to damage the eyes of preterm infants by giving too much oxygen especially in the first few weeks of life. Despite this knowledge there is still a wide variation in approaches to oxygen monitoring within neonatal units. A randomized controlled trial conducted more than 50 years ago first made clinicians aware of 'oxygen toxicity' in preterm infants, but no other controlled trial has ever been conducted since to clarify how much oxygen infants really need, or what oxygen saturation level is optimal in caring these preterm babies. Perhaps time has come for clinicians to resolve this 'uncertainty' by well-designed randomized trials.