TY - JOUR
T1 - Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks
AU - Saugstad, Ola Didrik
AU - Aune, Dagfinn
AU - Aguar, Marta
AU - Kapadia, Vishal
AU - Finer, Neil
AU - Vento, Maximo
PY - 2014/7
Y1 - 2014/7
N2 - 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.
AB - 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.
KW - Morbidity
KW - Mortality
KW - Oxygen
KW - Resuscitation
KW - Very low-birth-weight infants
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U2 - 10.1111/apa.12656
DO - 10.1111/apa.12656
M3 - Article
C2 - 24716824
AN - SCOPUS:84902137559
SN - 0803-5253
VL - 103
SP - 744
EP - 751
JO - Acta Paediatrica, International Journal of Paediatrics
JF - Acta Paediatrica, International Journal of Paediatrics
IS - 7
ER -