Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks

Ola Didrik Saugstad, Dagfinn Aune, Marta Aguar, Vishal Kapadia, Neil Finer, Maximo Vento

Research output: Contribution to journalArticlepeer-review

54 Scopus citations


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 iFiO 2 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, I 2 = 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 iFiO 2 (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.

Original languageEnglish (US)
Pages (from-to)744-751
Number of pages8
JournalActa Paediatrica, International Journal of Paediatrics
Issue number7
StatePublished - Jul 2014


  • Morbidity
  • Mortality
  • Oxygen
  • Resuscitation
  • Very low-birth-weight infants

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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