TY - JOUR
T1 - Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants
AU - Oei, Ju Lee
AU - Finer, Neil N.
AU - Saugstad, Ola Didrik
AU - Wright, Ian M.
AU - Rabi, Yacov
AU - Tarnow-Mordi, William
AU - Rich, Wade
AU - Kapadia, Vishal
AU - Rook, Denise
AU - Smyth, John P.
AU - Lui, Kei
AU - Vento, Maximo
N1 - Funding Information:
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.
Funding Information:
MV acknowledges RETICS funded by the PN 2018-2011 (Spain), ISCIIISub-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
Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Objective To determine the association between SpO 2 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 (FiO 2) 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 SpO 2 before 10 min of age. Patients Infants <32 weeks gestation. Main outcome measures Relationship between SpO 2 at 5 min, death and intraventricular haemorrhage (IVH) >grade 3. Results 5 min SpO 2 data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO 2 study targets and 323 (46%) did not reach SpO 2 80%. Pooled data showed decreased likelihood of reaching SpO 2 80% if resuscitation was initiated with FiO 2 <0.3 (OR 2.63, 95% CI 1.21 to 5.74, p<0.05). SpO 2 <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 SpO 2 80%. Conclusion Not reaching SpO 2 80% 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.
AB - Objective To determine the association between SpO 2 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 (FiO 2) 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 SpO 2 before 10 min of age. Patients Infants <32 weeks gestation. Main outcome measures Relationship between SpO 2 at 5 min, death and intraventricular haemorrhage (IVH) >grade 3. Results 5 min SpO 2 data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO 2 study targets and 323 (46%) did not reach SpO 2 80%. Pooled data showed decreased likelihood of reaching SpO 2 80% if resuscitation was initiated with FiO 2 <0.3 (OR 2.63, 95% CI 1.21 to 5.74, p<0.05). SpO 2 <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 SpO 2 80%. Conclusion Not reaching SpO 2 80% 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.
KW - neonatology
KW - resuscitation
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U2 - 10.1136/archdischild-2016-312366
DO - 10.1136/archdischild-2016-312366
M3 - Article
C2 - 28988158
AN - SCOPUS:85044248216
SN - 1359-2998
VL - 103
SP - F446-F454
JO - Archives of Disease in Childhood: Fetal and Neonatal Edition
JF - Archives of Disease in Childhood: Fetal and Neonatal Edition
IS - 5
ER -