Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO2 0.21 or 1.0

Thamrin, Valerie; Saugstad, Ola Didrik; Tarnow‐Mordi, William; Wang, Alex; Lui, Kei; Wright, Ian; Waal, Koert de; Travadi, Javeed; Smyth, John; Craven, P. D.; McMullan, Rowena L; Coates, Elisabeth; Ward, Meredith C.; Mishra, Parag; See, Kwee Ching; Cheah, Irene; Lim, Chin Theam; Choo, Yao Mun; Kamar, Azanna Ahmad; Cheah, Fook-Choe; Masoud, Ahmed; Oei, Ju Lee

doi:10.1016/j.jpeds.2018.05.053

Cited by 36 publications

(24 citation statements)

References 36 publications

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“…98 Secondary analyses Follow-up to the Torpido study, the largest RCT to examine low (0.21) vs. high (1.0) initial FiO 2 for preterm (<32 weeks gestation) infant resuscitation found no difference in the risk of death and/or major disability at 2 years. 105 However, in exploratory, secondary analyses, infants who did not attain a minimum 5 min SpO 2 of 80% were significantly more likely to be disabled/deceased than those with SpO 2 ≥80% (OR 1.33). Cognitive subscales on the Bayley III test were also higher, especially in infants ≥28 weeks gestation who had SpO 2 ≥80% (mean (SD) 100.8 (12.5) vs. 95.2 (12.4)).…”

Section: Human Datamentioning

confidence: 90%

“…102 Initial FiO 2 appears to have minimal impact on mortality or short-term morbidity for infants between 28 and 31 weeks gestations. [103][104][105] Data for infants <28 weeks gestation remain unclear, but there is indication from current evidence that regardless of initial FiO 2 , the amount of oxygen given to the infants should be manipulated to reach a target SpO 2 of 80-85% and a heart rate of 100 bpm within 5 min to decrease the risk of serious IVH and death. 98 It must also be remembered that data for "normal" physiological development of postnatal SpO 2 in this group are lacking and that clinicians must be cognizant of the need to adjust FiO 2 in response to the infant's individual need.…”

Section: Human Datamentioning

confidence: 99%

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Oxygen therapy of the newborn from molecular understanding to clinical practice

et al. 2018

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Oxygen is one of the most critical components of life. Nature has taken billions of years to develop optimal atmospheric oxygen concentrations for human life, evolving from very low, peaking at 30% before reaching 20.95%. There is now increased understanding of the potential toxicity of both too much and too little oxygen, especially for preterm and asphyxiated infants and of the potential and lifelong impact of oxygen exposure, even for a few minutes after birth. In this review, we discuss the contribution of knowledge gleaned from basic science studies and their implication in the care and outcomes of the human infant within the first few minutes of life and afterwards. We emphasize current knowledge gaps and research that is needed to answer a problem that has taken Nature a considerably longer time to resolve.

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Section: Human Datamentioning

confidence: 90%

Section: Human Datamentioning

confidence: 99%

Oxygen therapy of the newborn from molecular understanding to clinical practice

et al. 2018

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“…Follow up of the Torpido trial informed of the absence of differences in death or neurodevelopmental impairment at 2 years corrected age between the group resuscitated with an initial FiO 2 of 0.21 and 1.0 (19). Of note, in post hoc exploratory analyses infants who did not achieve SpO 2 >80% at 5 min after birth were more likely to die or have neurodevelopmental impairment (OR, 1.85; 1.07-3.2; P = 0.03) (23).…”

Section: Studies Supporting the Use Of Higher Initial Inspired Oxygenmentioning

confidence: 97%

Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth

et al. 2020

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Fetal to neonatal transition entails cardiorespiratory, hemodynamic, and metabolic changes coinciding with the switch from placental to airborne respiration with partial pressures of oxygen of 4-5 kPa in utero raising to 8-9 kPa ex utero in few minutes. Preterm infants have immature lung and antioxidant defense system. Very preterm infants (<32 weeks' gestation) frequently require positive pressure ventilation and oxygen to establish lung aeration, a functional residual capacity, and overcome a tendency toward hypoxemia and bradycardia in the first minutes after birth. Recent studies have shown that prolonged bradycardia (heart rate <100 beats per minute) and/or hypoxemia (oxygen saturation <80%) are associated with increased mortality and/or intracranial hemorrhage. However, despite the accumulated evidence, the way in which oxygen should be supplemented in the first minutes after birth still has not yet been clearly established. The initial inspired fraction of oxygen and its adjustment within a safe arterial oxygen saturation range measured by pulse oximetry that avoids hyper-or-hypoxia is still a matter of debate. Herewith, we present a current summary aiming to assist the practical neonatologist who has to aerate the lung and establish an efficacious respiration in very preterm infants in the delivery room.

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“…Infants were also less likely to reach SpO 2 80% if resuscitation was commenced with lower (≤0.3) FiO 2 instead of higher (>0.6) FiO 2 (OR 2.63, 95% CI 1.21–5.74) were more premature and had lower birth weight [27]. Similarly, Thamrin et al [28] reported the results of a follow up study at 2–3 years corrected age of preterm babies born at <32 weeks’ gestation and resuscitated with FiO 2 or either 0.21 or 1.0. They found no differences in Bayley Scales independently of the initial FiO 2 employed.…”

Section: Target Oxygen Saturation During Stabilizationmentioning

confidence: 99%

“…Interestingly, in a post hoc exploratory analysis of the entire cohort, babies who did not reach SpO 2 80% at five minutes after birth were more likely to die or have neurodevelopmental impairment (OR, 1.85; 95% CI 1.07–3.2; P = 0.03). From the results of these studies [27,28], it may be deduced that more than starting with a specific FiO 2 , performing an adequate ventilation and oxygen titration that allows the patient reaching a specific SpO 2 at a given time point after birth has a notable influence on major outcomes. Inability to do so could be informing about prenatal complications in utero or inadequate resuscitation.…”

Section: Target Oxygen Saturation During Stabilizationmentioning

confidence: 99%

Optimal Inspired Fraction of Oxygen in the Delivery Room for Preterm Infants

Lara-Cantón¹,

Solaz²,

Parra-Llorca³

et al. 2019

Children

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Postnatal adaptation of preterm infants entails a series of difficulties among which the immaturity of the respiratory system is the most vital. To overcome respiratory insufficiency, caregivers attending in the delivery room use positive pressure ventilation and oxygen. A body of evidence in relation of oxygen management in the delivery room has been accumulated in recent years; however, the optimal initial inspired fraction of oxygen, the time to achieve specific oxygen saturation targets, and oxygen titration have not been yet clearly established. The aim of this review is to update the reader by critically analyzing the most relevant literature.

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Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO2 0.21 or 1.0

Cited by 36 publications

References 36 publications

Oxygen therapy of the newborn from molecular understanding to clinical practice

Oxygen therapy of the newborn from molecular understanding to clinical practice

Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth

Optimal Inspired Fraction of Oxygen in the Delivery Room for Preterm Infants

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