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 journalArticle

45 Citations (Scopus)

Abstract

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 iFiO2 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, I(2) = 0%, p(heterogeneity) = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95% CI: 0.73-1.68, I(2) = 46%, p(heterogeneity) = 0.06); and for intraventricular haemorrhage, it was 0.90 (95% CI: 0.53-1.53, I(2) = 9%, p(heterogeneity) = 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 iFiO2 (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 (Oslo, Norway : 1992)
Volume103
Issue number7
DOIs
StatePublished - Jul 1 2014

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Delivery Rooms
Meta-Analysis
Bronchopulmonary Dysplasia
Oxygen
Premature Infants
Pregnancy
Hemorrhage
Mortality
Resuscitation
Newborn Infant
Guidelines

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks. / Saugstad, Ola Didrik; Aune, Dagfinn; Aguar, Marta; Kapadia, Vishal; Finer, Neil; Vento, Maximo.

In: Acta paediatrica (Oslo, Norway : 1992), Vol. 103, No. 7, 01.07.2014, p. 744-751.

Research output: Contribution to journalArticle

Saugstad, Ola Didrik ; Aune, Dagfinn ; Aguar, Marta ; Kapadia, Vishal ; Finer, Neil ; Vento, Maximo. / Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at ≤32 weeks. In: Acta paediatrica (Oslo, Norway : 1992). 2014 ; Vol. 103, No. 7. pp. 744-751.
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abstract = "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 iFiO2 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, I(2) = 0{\%}, p(heterogeneity) = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95{\%} CI: 0.73-1.68, I(2) = 46{\%}, p(heterogeneity) = 0.06); and for intraventricular haemorrhage, it was 0.90 (95{\%} CI: 0.53-1.53, I(2) = 9{\%}, p(heterogeneity) = 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 iFiO2 (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.",
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AU - Saugstad, Ola Didrik

AU - Aune, Dagfinn

AU - Aguar, Marta

AU - Kapadia, Vishal

AU - Finer, Neil

AU - Vento, Maximo

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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 iFiO2 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, I(2) = 0%, p(heterogeneity) = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95% CI: 0.73-1.68, I(2) = 46%, p(heterogeneity) = 0.06); and for intraventricular haemorrhage, it was 0.90 (95% CI: 0.53-1.53, I(2) = 9%, p(heterogeneity) = 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 iFiO2 (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 iFiO2 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, I(2) = 0%, p(heterogeneity) = 0.88) for low versus high iFiO2 ; for bronchopulmonary dysplasia, it was 1.11 (95% CI: 0.73-1.68, I(2) = 46%, p(heterogeneity) = 0.06); and for intraventricular haemorrhage, it was 0.90 (95% CI: 0.53-1.53, I(2) = 9%, p(heterogeneity) = 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 iFiO2 (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.

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