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Biomedical subjects

Win Tin

Publications and source records attributed to Win Tin.

7 recordsLinked to original sources
PubMed2006

Caffeine therapy for apnea of prematurity.

BACKGROUND: Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight. METHODS: We randomly assigned 2006 infants with birth weights of 500 to 1250 g during the first 10 days of life to receive either caffeine or placebo, until drug therapy for apnea of prematurity was no longer needed. We evaluated the short-term outcomes before the first discharge home. RESULTS: Of 963 infants who were assigned to caffeine and who remained alive at a postmenstrual age of 36 weeks, 350 (36 percent) received supplemental oxygen, as did 447 of the 954 infants (47 percent) assigned to placebo (adjusted odds ratio, 0.63; 95 percent confidence interval, 0.52 to 0.76; P<0.001). Positive airway pressure was discontinued one week earlier in the infants assigned to caffeine (median postmenstrual age, 31.0 weeks; interquartile range, 29.4 to 33.0) than in the infants in the placebo group (median postmenstrual age, 32.0 weeks; interquartile range, 30.3 to 34.0; P<0.001). Caffeine reduced weight gain temporarily. The mean difference in weight gain between the group receiving caffeine and the group receiving placebo was greatest after two weeks (mean difference, -23 g; 95 percent confidence interval, -32 to -13; P<0.001). The rates of death, ultrasonographic signs of brain injury, and necrotizing enterocolitis did not differ significantly between the two groups. CONCLUSIONS: Caffeine therapy for apnea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312.).

Apnea↗
PubMed2004

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.

History, 18th Century↗
PubMed2003

Oxygen monitoring in preterm babies: too high, too low?

A small randomised trial in 1952 showed that excess oxygen use might well be causing a major epidemic of retinal blindness in preterm babies. That single study of just 65 babies was enough to throw doubt on a longstanding treatment strategy of oxygen therapy and highlighted just how powerful a tool the randomised controlled trial could be. Confirmatory evidence from a co-operative trial 4 years later involving 212 babies banished all residual doubt and we should reproach ourselves that we have still not learnt after 50 years how to optimise oxygen delivery to the preterm baby, making further use of this powerful research tool. Two well-conducted trials have recently shown that avoiding subclinical hypoxaemia (a fractional SaO(2) of less than 92%) in babies more than a month old does nothing to improve later growth or development. It is now time the same question was asked of babies less than a month old. This is particularly important in babies of less than 28 weeks' gestation, who currently remain at serious risk of chronic lung disease and permanent retinal damage.

History, 20th Century↗
PubMed2003

The controversies surrounding oxygen therapy in neonatal intensive care units.

Despite the knowledge that excess amounts of oxygen in the blood (hyperoxia) can be damaging to preterm infants, there is a wide variation in approaches to oxygen therapy within neonatal intensive care units. This is predominantly determined by institutional or individual practices or preferences and might stem from a lack of understanding of the relative merits and demerits of the different techniques of oxygen monitoring in extremely preterm babies who are different from more mature babies. This article provides the physiological rationale and evidence from recent clinical studies suggesting that keeping the oxygen therapy to an "acceptable" minimum in premature babies does not do any harm and may be even advantageous.

Disease Progression↗
PubMed2002

Giving small babies oxygen: 50 years of uncertainty.

A small landmark trial in 1952 showed that excess oxygen use might well be causing a major epidemic of retinal blindness in preterm babies. That a single study of just 65 babies was enough to throw doubt on a long-standing treatment strategy revealed just how powerful a tool the randomized controlled trial could be. Confirmatory evidence from a cooperative trial involving a further 212 babies banished all residual doubt just 4 years later, and it remains a major reproach that we have still not learnt, after 50 years, how to optimize the delivery of oxygen to the preterm baby with further help from this powerful tool. Two well-conducted trials have recently shown that avoiding subclinical hypoxaemia (fractional SaO(2)<92%) in babies more than a month old does nothing to improve later growth or development. It is now time the same question was asked of babies less than a month old, because we might reduce their need for ventilatory support. This is particularly important in babies of less than 28 weeks' gestation, who remain, currently, at serious risk of chronic lung disease and permanent retinal scarring.

Australia↗