Use of oxygen in the resuscitation of preterm infants: current opinion and practice in Australia and New Zealand.

AIM

The aim of this paper was to explore the opinions and practices of tertiary health-care professionals in Australia and New Zealand regarding air and oxygen blending (OB) for the resuscitation of preterm infants.

METHODS

Structured questionnaires were sent to the directors of 25 tertiary perinatal units, with instructions to distribute the questionnaires to 15 pertinent clinical staff.

RESULTS

Response rate was 72% (n = 271); medical-staff response was 25%. Sixteen (64%) perinatal units had OB resuscitation equipment. Among respondents, 114 (42%) had access to OB and 73 (27%) had OB for all resuscitations. Pulse oximetry was available to 160 (59%) of respondents. The majority (173, 64%) would initiate resuscitation with Fractional inspired oxygen (FiO(2)) ranging from 0.3 to 0.9 (mean 0.5), with 15% and 21% preferring air and 100% oxygen, respectively. There were large variations in managing FiO(2) changes thereafter. Half of the respondents were either unsure (39%) or not convinced (15%) that 100% oxygen during resuscitation would cause harm. Conversely, 42% suggested that OB might improve outcome with bronchopulmonary dysplasia and retinopathy of prematurity being the most important considerations. Most (92%) would advocate for OB in the delivery suite. Set-up cost (50%) and lack of guided experience (38%) ranked highest as barriers to change.

CONCLUSIONS

Two-thirds of the tertiary centres have at least some OB equipment in the delivery suite, but the ways and opinions in which OB is utilised differ widely. Most practitioners would advocate for a change. There is an urgent need for further research to achieve a consistent and meaningful clinical management for OB resuscitation of preterm infants.