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Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants
  1. Ju Lee Oei1,2,3,
  2. Neil N Finer4,5,
  3. Ola Didrik Saugstad6,
  4. Ian M Wright7,
  5. Yacov Rabi8,9,
  6. William Tarnow-Mordi3,
  7. Wade Rich5,
  8. Vishal Kapadia10,
  9. Denise Rook11,
  10. John P Smyth1,2,
  11. Kei Lui1,2,
  12. Maximo Vento12
  1. 1Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia
  2. 2School of Women’s and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
  3. 3Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
  4. 4Department of Pediatrics, Neonatology, University of California, San Diego, California, USA
  5. 5Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA
  6. 6Department of Pediatric Research, The University of Oslo, Oslo University Hospital, Oslo, Norway
  7. 7Illawarra Health and Medical Research Institute and Graduate Medicine, The University of Wollongong, Wollongong, New South Wales, Australia
  8. 8Department of Neonatology, University of Calgary, Alberta, Canada
  9. 9Alberta Children’s Hospital Research Institute, Alberta, Canada
  10. 10Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
  11. 11Department of Pediatrics, Neonatology, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, The Netherlands
  12. 12Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain
  1. Correspondence to Dr Ju Lee Oei, Department of Newborn Care, The Royal Hospital for Women, Randwick NSW 2031, Australia; j.oei{at}unsw.edu.au

Abstract

Objective To determine the association between SpO2 at 5 min and preterm infant outcomes.

Design Data from 768 infants <32 weeks gestation from 8 randomised controlled trials (RCTs) of lower (≤0.3) versus higher (≥0.6) initial inspiratory fractions of oxygen (FiO2) for resuscitation, were examined.

Setting Individual patient analysis of 8 RCTs

Interventions Lower (≤0.3) versus higher (≥0.6) oxygen resuscitation strategies targeted to specific predefined SpO2 before 10 min of age.

Patients Infants <32 weeks gestation.

Main outcome measures Relationship between SpO2 at 5 min, death and intraventricular haemorrhage (IVH) >grade 3.

Results 5 min SpO2 data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO2 study targets and 323 (46%) did not reach SpO280%. Pooled data showed decreased likelihood of reaching SpO280% if resuscitation was initiated with FiO2 <0.3 (OR 2.63, 95% CI 1.21 to 5.74, p<0.05). SpO2 <80% was associated with lower heart rates (mean difference −8.37, 95% CI −15.73 to –1.01, *p<0.05) and after accounting for confounders, with IVH (OR 2.04, 95% CI 1.01 to 4.11, p<0.05). Bradycardia (heart rate <100 bpm) at 5 min increased risk of death (OR 4.57, 95% CI 1.62 to 13.98, p<0.05). Taking into account confounders including gestation, birth weight and 5 min bradycardia, risk of death was significantly increased with time taken to reach SpO280%.

Conclusion Not reaching SpO280% at 5 min is associated with adverse outcomes, including IVH. Whether this is because of infant illness or the amount of oxygen that is administered during stabilisation is uncertain and needs to be examined in randomised trials

  • resuscitation
  • neonatology

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Footnotes

  • Contributors JLO: developed project idea with MV, performed statistical analysis, drafted initial manuscript and revisions and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. NF: supervised project, substantially contributed to project design, data analysis and interpretation, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. ODS: supervised project, substantially contributed to project design, data analysis and interpretation, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. IMW: contributed intellectual content, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. YR: substantially contributed to project design, data analysis and interpretation, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. WTM: substantially contributed to project design, data analysis and interpretation, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. WR: contributed intellectual content, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. VK: provided statistical advice, substantially contributed to project design, data analysis and interpretation, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DR: provided data, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. JS: contributed intellectual content, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. KL: contributed intellectual content, revised, reviewed and approved final manuscript to be submitted. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MV: substantially contributed to project design, data analysis and interpretation, revised, reviewed and approved final manuscript to be submitted, provided data, developed project idea together with JLO, overall supervisor of project. Agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All authors have approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding MV acknowledges RETICS funded by the PN 2018-2011 (Spain), ISCIII-Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (FEDER), reference RD12/0026. VK acknowledges support by K23HD083511 grant by NIH.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Additional pooled data that are not yet published are available to VK and JLO.

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