Making a choice: initial fraction of inspired oxygen for resuscitation at birth of a premature infant less than 32 weeks gestational age

Abstract

As briefly noted by Abdel-Hady and Nasef in their 2012 publication in Research and Reports in Neonatology, 1 the best initial fraction of inspired oxygen (FiO 2 ) to use during resuscitation of preterm neonates ,32 weeks gestational age (GA) has not been clearly elucidated. Most recent neonatal resuscitation guidelines leave the difficult choice of the actual FiO 2 in the hands of individual physicians. We believe that this letter, through review and discussion of the recent published literature, will aid physicians in this choice and confirm that, as per the opinion of Abdel-Hady and Nasef, the best present evidence-based choice for the initial FiO 2 for resuscitating preterm infants ,32 weeks GA appears to be 30%. However, determination of the ideal initial resuscitation gas requires further research assessing both short-term and long-term outcomes.The common clinical scenario of attending the birth of a premature infant brings up an important clinical question: in an infant born at ,32 weeks GA (population), does the use of a low level of oxygen (#30%, intervention) instead of a high level of oxygen ($90%, comparison) as the initial FiO 2 for resuscitation result in adequate stabilization (outcome)? In order to answer this question, we sought recent randomized controlled trials (RCTs) examining the desired patient population, intervention, comparison, and outcome. We performed a PubMed search covering January 2008 until October 2013 using the following keywords: "oxygen" AND "resuscitation" AND "premature infant". Limits were: human species, English language, and age from birth to 23 months. Publications prior to January 2008 were excluded because of redundancy, lack of applicability, or outdated information being likely in these publications. We examined personal files and reference listings of the full-text articles for any additional publications. Our search yielded a total of 141 titles. We reviewed 44 abstracts and retrieved 21 full-text articles or conference proceedings for detailed review.