Importance: There are potential benefits and harms of hyperoxemia and hypoxemia for extremely preterm infants receiving more or less supplemental oxygen. Objective: To compare the effects of different pulse oximeter oxygen saturation (SpO2) target ranges on death or major morbidity.Design, Setting, and Participants: Prospectively planned, individual participant data meta-analysis of five randomized clinical trials (conducted 2005-2014), enrolling infants born at less than 28 weeks' gestation.Exposure: Targeting a lower (85-89%) versus higher (91-95%) SpO2 range. Main Outcomes and Measures:The primary outcome was a composite of death or major disability by 18-24 months' corrected age (bilateral blindness, deafness, cerebral palsy with the Gross Motor Function Classification System (GMFCS) level 2 or higher, or Bayley-III cognitive or language score less than 85). There were 16 secondary outcomes including death, major disability, retinopathy of prematurity (ROP) requiring treatment, blindness, severe necrotizing enterocolitis (NEC).

Plasma manganese levels were determined at birth and then serially to 3 months of age in 40 very low birth weight (VLBW) infants (mean birth weight 1,027 g). Mean plasma manganese concentration was 3.6 μg/l at birth and 3.0 μg/l at 3 months of age. These levels were approximately 3-fold greater than those of a group of 9 adults analysed using the same methods (mean 1.1 μg/l). Manganese was also measured in parenteral nutrition fluids, breast milk and 3 preterm formulas. There was no relationship between manganese intake and plasma manganese concentration.

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original articleT h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 371;2 nejm. ConclusionsModerate hypothermia after perinatal asphyxia resulted in improved neurocognitive outcomes in middle childhood. (Funded by the United Kingdom Medical Research Council and others; TOBY ClinicalTrials.gov number, NCT01092637.) The New England Journal of Medicine Downloaded from nejm.org at KINGS COLLEGE LONDON on January 6, 2016. For personal use only. No other uses without permission.

Very low birth weight infants often receive multiple blood transfusions. We measured the plasma levels of the trace elements selenium, manganese, and glutathione peroxidase in 20 very low birth weight infants prior to blood transfusion and then at 24, 48 and 72 h after transfusion. There was no detectable change in mean selenium or glutathione peroxidase concentrations after transfusion, but the mean (SD) plasma manganese increased from 3.8 (1.5) to 6.0 (2.3) μg/l at 72 h.

Significant economies of scale may be attainable. Nevertheless, these results should be carefully interpreted. In particular, the costs of neonatal care should not be examined in isolation but in relation to outcomes. In certain instances, units of inefficient scale but acceptable outcome may be defensible on grounds of ease of access.

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