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

Ju Lee Oei, Neil N. Finer, Ola Didrik Saugstad, Ian M. Wright, Yacov Rabi, William Tarnow-Mordi, Wade Rich, Vishal Kapadia, Denise Rook, John P. Smyth, Kei Lui, Maximo Vento

Research output: Contribution to journalArticle

26 Citations (Scopus)

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.

Original languageEnglish (US)
JournalArchives of Disease in Childhood: Fetal and Neonatal Edition
DOIs
StateAccepted/In press - Oct 7 2017

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Delivery Rooms
Premature Infants
Oxygen
Bradycardia
Heart Rate
Birth Weight
Resuscitation
Pregnancy

Keywords

  • neonatology
  • resuscitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants. / Oei, Ju Lee; Finer, Neil N.; Saugstad, Ola Didrik; Wright, Ian M.; Rabi, Yacov; Tarnow-Mordi, William; Rich, Wade; Kapadia, Vishal; Rook, Denise; Smyth, John P.; Lui, Kei; Vento, Maximo.

In: Archives of Disease in Childhood: Fetal and Neonatal Edition, 07.10.2017.

Research output: Contribution to journalArticle

Oei, Ju Lee ; Finer, Neil N. ; Saugstad, Ola Didrik ; Wright, Ian M. ; Rabi, Yacov ; Tarnow-Mordi, William ; Rich, Wade ; Kapadia, Vishal ; Rook, Denise ; Smyth, John P. ; Lui, Kei ; Vento, Maximo. / Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants. In: Archives of Disease in Childhood: Fetal and Neonatal Edition. 2017.
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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

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N2 - 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.

AB - 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.

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