Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: a meta-analysis

Fecha de publicación: 01/01/2017

Autores de IIS La Fe

Máximo Vento Torres

Autor

Participantes ajenos a IIS La Fe

Oei, JL
Rabi, Y
Wright, I
Finer, N
Rich, W
Kapadia, V
Aune, D
Rook, D
Tarnow-Mordi, W
Saugstad, OD

Grupos

Perinatología

Leader

Máximo Vento Torres

Abstract

Objective To systematically review outcomes of infants <= 28+6 weeks gestation randomised to resuscitation with low (<= 0.3) vs high (>= 0.6) fraction of inspired oxygen (FiO(2)) at delivery. Design Systematic review of randomised controlled trials of low (<= 0.3) vs high (>= 0.6) FiO(2) resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/resuscitation/oxygen. Data for infants <= 28+6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. Main outcome measures Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). Results A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). Conclusions There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (<= 0.30) or higher (>= 0.6) FiO(2) in infants <= 28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.

Datos de la publicación

ISSN/ISSNe:: 1359-2998, 1468-2052
Tipo:: Article
Páginas:: 24-30
DOI:: 10.1136/archdischild-2016-310435
PubMed:: 27150977
Factor de Impacto:: 1,837 SCImago ℠
Cuartil:: Q1 SCImago ℠

Documentos

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Métricas

Filiaciones

Oei, JL:: Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia

School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia

NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia

Royal Hosp Women, Dept Newborn Care, Randwick, NSW 2031, Australia

Univ New South Wales, Sch Womens & Childrens Hlth, Randwick, NSW, Australia

Univ Sydney, NHMRC Clin Trials Ctr, Camperdown, NSW, Australia
Vento, M:: Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain

Univ & Polytech Hosp La Fe, Div Neonatol, Valencia, Spain
Rabi, Y:: Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada

Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada

Univ Calgary, Dept Paediat, Calgary, AB, Canada

Alberta Childrens Prov Gen Hosp, Res Inst, Calgary, AB, Canada
Wright, I:: Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia

Univ Wollongong, Illawarra Hlth & Med Res Inst, Wollongong, NSW, Australia

Univ Wollongong, Grad Sch Med, Wollongong, NSW, Australia
Finer, N:: Department of Pediatrics, Neonatology, University of California, San Diego, California, USA

Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA

Univ Calif San Diego, Dept Pediat, Neonatol, San Diego, CA 92103 USA

Sharp Mary Birch Hosp Women & Newborns, San Diego, CA USA
Rich, W:: Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA

Sharp Mary Birch Hosp Women & Newborns, San Diego, CA USA
Kapadia, V:: Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA

Univ Texas Southwestern Med Ctr Dallas, Div Neonatal Perinatal Med, Dallas, TX 75390 USA
Aune, D:: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK

Imperial Coll London, Sch Publ Hlth, Dept Epidemiol & Biostat, London, England
Rook, D:: Sophia Childrens Univ Hosp, Erasmus Med Ctr, Dept Pediat, Div Neonatol, Rotterdam, Netherlands
Tarnow-Mordi, W:: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia

Univ Sydney, NHMRC Clin Trials Ctr, Camperdown, NSW, Australia
Saugstad, OD:: Department of Pediatric Research, University of Oslo, Oslo University Hospital, Oslo, Norway

Univ Oslo, Oslo Univ Hosp, Dept Pediat Res, Oslo, Norway