Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants

Authors

Ju Lee Oei, University of New South Wales, Royal Hospital For Women, University of Sydney
Neil Finer, University of California at San Diego, Sharp Mary Birch Hospital for Women and Newborns
Ola Saugstad, University of Oslo
Ian M. R Wright, University of WollongongFollow
Yacov Rabi, University of Calgary, Alberta Children's Hospital Research Institute
William O. Tarnow-Mordi, University of Sydney
Wade Rich, Sharp Mary Birch Hospital for Women and Newborns
Vishal Kapadia, UT Southwestern Medical Center at Dallas
Denise Rook, Sophia Children's Hospital
John Smyth, University of New South Wales, Royal Hospital for Women
Kei Lui, University of New South Wales, Royal Hospital For Women
Maximo Vento, University of New South Wales, Royal Hospital For Women

RIS ID

135702

Publication Details

Oei, J., Finer, N. N., Saugstad, O. Didrik., Wright, I. M., Rabi, Y., Tarnow-Mordi, W., Rich, W., Kapadia, V., Rook, D., Smyth, J. P., Lui, K. & Vento, M. (2018). Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants. Archives Of Disease In Childhood-fetal And Neonatal Edition, 103 (5), F446-F454.

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