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

OBJECTIVE

To determine the association between SpO 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 (FiO) 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 SpO before 10 min of age.

PATIENTS

Infants <32 weeks gestation.

MAIN OUTCOME MEASURES

Relationship between SpO at 5 min, death and intraventricular haemorrhage (IVH) >grade 3.

RESULTS

5 min SpO data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO study targets and 323 (46%) did not reach SpO80%. Pooled data showed decreased likelihood of reaching SpO80% if resuscitation was initiated with FiO <0.3 (OR 2.63, 95% CI 1.21 to 5.74, p<0.05). SpO <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 SpO80%.

CONCLUSION

Not reaching SpO80% 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.