RT Journal Article
SR Electronic
T1 Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP fetalneonatal-2016-312366
DO 10.1136/archdischild-2016-312366
A1 Ju Lee Oei
A1 Neil N Finer
A1 Ola Didrik Saugstad
A1 Ian M Wright
A1 Yacov Rabi
A1 William Tarnow-Mordi
A1 Wade Rich
A1 Vishal Kapadia
A1 Denise Rook
A1 John P Smyth
A1 Kei Lui
A1 Maximo Vento
YR 2017
UL http://fn.bmj.com/content/early/2017/10/07/archdischild-2016-312366.abstract
AB 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 RCTsInterventions 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