Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: A meta-analysis

Ju Lee Oei, Maximo Vento, Yacov Rabi, Ian Wright, Neil Finer, Wade Rich, Vishal Kapadia, Dagfinn Aune, Denise Rook, William Tarnow-Mordi, Ola D. Saugstad

Research output: Contribution to journalArticle

Abstract

Objective To systematically review outcomes of infants =28+6 weeks gestation randomised to resuscitation with low (=0.3) vs high (=0.6) fraction of inspired oxygen (FiO2) at delivery. Design Systematic review of randomised controlled trials of low (=0.3) vs high (=0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants =28 +6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. Main outcome measures Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). Results A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). Conclusions There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (=0.30) or higher (=0.6) FiO2 in infants =28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.

Original languageEnglish (US)
JournalArchives of Disease in Childhood
DOIs
StateAccepted/In press - May 5 2016

Fingerprint

Delivery Rooms
Premature Infants
Resuscitation
Meta-Analysis
Oxygen
Pregnancy
Bronchopulmonary Dysplasia
Necrotizing Enterocolitis
Patent Ductus Arteriosus
Retinopathy of Prematurity
Mortality
Randomized Controlled Trials
Outcome Assessment (Health Care)
Databases
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation : A meta-analysis. / Oei, Ju Lee; Vento, Maximo; Rabi, Yacov; Wright, Ian; Finer, Neil; Rich, Wade; Kapadia, Vishal; Aune, Dagfinn; Rook, Denise; Tarnow-Mordi, William; Saugstad, Ola D.

In: Archives of Disease in Childhood, 05.05.2016.

Research output: Contribution to journalArticle

Oei, Ju Lee ; Vento, Maximo ; Rabi, Yacov ; Wright, Ian ; Finer, Neil ; Rich, Wade ; Kapadia, Vishal ; Aune, Dagfinn ; Rook, Denise ; Tarnow-Mordi, William ; Saugstad, Ola D. / Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation : A meta-analysis. In: Archives of Disease in Childhood. 2016.
@article{e1f1b2efb4254e2588146a7a8e1da1fa,
title = "Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: A meta-analysis",
abstract = "Objective To systematically review outcomes of infants =28+6 weeks gestation randomised to resuscitation with low (=0.3) vs high (=0.6) fraction of inspired oxygen (FiO2) at delivery. Design Systematic review of randomised controlled trials of low (=0.3) vs high (=0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants =28 +6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. Main outcome measures Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). Results A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95{\%} CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). Conclusions There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (=0.30) or higher (=0.6) FiO2 in infants =28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.",
author = "Oei, {Ju Lee} and Maximo Vento and Yacov Rabi and Ian Wright and Neil Finer and Wade Rich and Vishal Kapadia and Dagfinn Aune and Denise Rook and William Tarnow-Mordi and Saugstad, {Ola D.}",
year = "2016",
month = "5",
day = "5",
doi = "10.1136/archdischild-2016-310435",
language = "English (US)",
journal = "Archives of Disease in Childhood",
issn = "0003-9888",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation

T2 - A meta-analysis

AU - Oei, Ju Lee

AU - Vento, Maximo

AU - Rabi, Yacov

AU - Wright, Ian

AU - Finer, Neil

AU - Rich, Wade

AU - Kapadia, Vishal

AU - Aune, Dagfinn

AU - Rook, Denise

AU - Tarnow-Mordi, William

AU - Saugstad, Ola D.

PY - 2016/5/5

Y1 - 2016/5/5

N2 - Objective To systematically review outcomes of infants =28+6 weeks gestation randomised to resuscitation with low (=0.3) vs high (=0.6) fraction of inspired oxygen (FiO2) at delivery. Design Systematic review of randomised controlled trials of low (=0.3) vs high (=0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants =28 +6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. Main outcome measures Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). Results A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). Conclusions There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (=0.30) or higher (=0.6) FiO2 in infants =28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.

AB - Objective To systematically review outcomes of infants =28+6 weeks gestation randomised to resuscitation with low (=0.3) vs high (=0.6) fraction of inspired oxygen (FiO2) at delivery. Design Systematic review of randomised controlled trials of low (=0.3) vs high (=0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants =28 +6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. Main outcome measures Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). Results A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). Conclusions There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (=0.30) or higher (=0.6) FiO2 in infants =28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.

UR - http://www.scopus.com/inward/record.url?scp=84973106793&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84973106793&partnerID=8YFLogxK

U2 - 10.1136/archdischild-2016-310435

DO - 10.1136/archdischild-2016-310435

M3 - Article

C2 - 27150977

JO - Archives of Disease in Childhood

JF - Archives of Disease in Childhood

SN - 0003-9888

ER -