Systematic review and meta-analysis of optimal initial fraction of oxygen levels in the delivery room at <= 32weeks

Autores de IIS La Fe

• Marta Aguar Carrascosa

  Autor

• Máximo Vento Torres

  Autor

Participantes ajenos a IIS La Fe

• Saugstad OD
• Aune D
• Kapadia V
• Finer N

Grupos

• Perinatología

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 32weeks' gestation. Methods Our systematic review and meta-analysis studied the effects of low and high iFiO2 during the resuscitation/stabilisation of 677 newborn babies 32weeks' 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, I2=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 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 32weeks' gestation in need of stabilisation in the delivery room should be given an iFiO2 of 0.21-0.30.

Keywords

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