Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32weeks
Author(s)
Type
Journal Article
Abstract
Aim
The optimal initial fraction of oxygen (iFiO2) for resuscitating/stabilising premature infants is not known. We aimed to study currently available information and provide guidelines regarding the iFiO2 levels needed to resuscitate/stabilise premature infants of ≤32 weeks' gestation.
Methods
Our systematic review and meta-analysis studied the effects of low and high iFiO2 during the resuscitation/stabilisation of 677 newborn babies ≤32 weeks' gestation.
Results
Ten randomised studies were identified covering 321 infants receiving low (0.21–0.30) iFiO2 levels and 356 receiving high (0.60–1.0) levels. Relative risk for mortality was 0.62 (95% CI: 0.37–1.04, I2 = 0%, pheterogeneity = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95% CI: 0.73–1.68, I2 = 46%, pheterogeneity = 0.06); and for intraventricular haemorrhage, it was 0.90 (95% CI: 0.53–1.53, I2 = 9%, pheterogeneity = 0.36).
Conclusion
These data show that reduced mortality approached significance when a low iFiO2 (0.21–0.30) was used for initial stabilisation, compared to a high iFiO2 (0.60–1.0). There was no significant association for bronchopulmonary dysplasia or intraventricular haemorrhage when comparing low and high iFiO2. Based on present data, premature babies ≤32 weeks' gestation in need of stabilisation in the delivery room should be given an iFiO2 of 0.21–0.30.
Key notes
The optimal initial fraction of oxygen (FiO2) for resuscitating/stabilising premature infants of ≤32 weeks' gestation is not known.
Our analysis of 10 published studies covering 677 infants shows that the results of starting with a low initial FiO2 (0.21–0.30) were as good as starting with a high FiO2 (0.6–1.0).
Until more data from randomised trials are available, we suggest initiating resuscitation/stabilisation of these babies with a low (0.21–0.30) FiO2.
The optimal initial fraction of oxygen (iFiO2) for resuscitating/stabilising premature infants is not known. We aimed to study currently available information and provide guidelines regarding the iFiO2 levels needed to resuscitate/stabilise premature infants of ≤32 weeks' gestation.
Methods
Our systematic review and meta-analysis studied the effects of low and high iFiO2 during the resuscitation/stabilisation of 677 newborn babies ≤32 weeks' gestation.
Results
Ten randomised studies were identified covering 321 infants receiving low (0.21–0.30) iFiO2 levels and 356 receiving high (0.60–1.0) levels. Relative risk for mortality was 0.62 (95% CI: 0.37–1.04, I2 = 0%, pheterogeneity = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95% CI: 0.73–1.68, I2 = 46%, pheterogeneity = 0.06); and for intraventricular haemorrhage, it was 0.90 (95% CI: 0.53–1.53, I2 = 9%, pheterogeneity = 0.36).
Conclusion
These data show that reduced mortality approached significance when a low iFiO2 (0.21–0.30) was used for initial stabilisation, compared to a high iFiO2 (0.60–1.0). There was no significant association for bronchopulmonary dysplasia or intraventricular haemorrhage when comparing low and high iFiO2. Based on present data, premature babies ≤32 weeks' gestation in need of stabilisation in the delivery room should be given an iFiO2 of 0.21–0.30.
Key notes
The optimal initial fraction of oxygen (FiO2) for resuscitating/stabilising premature infants of ≤32 weeks' gestation is not known.
Our analysis of 10 published studies covering 677 infants shows that the results of starting with a low initial FiO2 (0.21–0.30) were as good as starting with a high FiO2 (0.6–1.0).
Until more data from randomised trials are available, we suggest initiating resuscitation/stabilisation of these babies with a low (0.21–0.30) FiO2.
Date Issued
2014-07-01
Date Acceptance
2014-04-07
Citation
Acta Paediatrica: promoting child health, 2014, 103 (7), pp.744-751
ISSN
0803-5253
Publisher
Wiley
Start Page
744
End Page
751
Journal / Book Title
Acta Paediatrica: promoting child health
Volume
103
Issue
7
Copyright Statement
Copyright ©2014 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 2014. This is the peer reviewed version of the following article: Saugstad, O.D., Aune, D., Aguar, M., Kapadia, V., Finer, N. and Vento, M. (2014), Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks. Acta Paediatr, 103: 744-751. https://doi.org/10.1111/apa.12656, which has been published in final form at [Link to final article using the DOI]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
Identifier
https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000337572700023&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=a2bf6146997ec60c407a63945d4e92bb
Subjects
AIR
BIRTH
LESS OXIDATIVE STRESS
Life Sciences & Biomedicine
Morbidity
Mortality
NEWBORN-INFANTS
Oxygen
Pediatrics
PRETERM INFANTS
Resuscitation
RESUSCITATION
SATURATION
Science & Technology
Very low-birth-weight infants
Publication Status
Published
Coverage Spatial
Norway
Date Publish Online
2014-04-10