Skip Ribbon Commands
Skip to main content
SharePoint

PublicComment

 Feedback

If you have any comments or questions on this page, please email us at:
 

Oxygen concentration for resuscitating premature newborns

Question Type:
Intervention
Full Question:
Among preterm newborns who receive positive pressure ventilation in the delivery room (P), does low initial oxygen (21-30%) (I), compared with high initial high oxygen (50-100%) (C), change improve survival (O)?
Consensus on Science:
For the critical outcome of mortality before discharge, we found moderate-quality evidence from 7 randomized clinical trials enrolling 607 subjects showing no benefit to beginning resuscitation with high-oxygen as compared with low-oxygen concentration (RR, 1.48; 95% CI, 0.8–2.73). The quality of evidence was downgraded for imprecision. (Lundstrom 1995, F81; Wang 2008, 1083; Vento 2009, e439; Rabi 2011, e374; Armanian 2012, 25; Kapadia 2013, e1488; Rook 2014, 1322) When limited to randomized clinical trials with concealed allocation and oxygen targeting as a cointervention, we found moderate-quality evidence from 5 trials enrolling 468 subjects showing no benefit to beginning resuscitation with a high-oxygen concentration as compared with low-oxygen concentration (RR, 1.33; 95% CI, 0.68–2.62). The quality of evidence was downgraded for imprecision. (Wang 2008, 1083; Vento 2009, e439; Rabi 2011, e374; Kapadia 2013, e1488; Rook 2014, 1322) We found very-low-quality evidence from 1 cohort study including 125 subjects showing no benefit to beginning resuscitation with high-oxygen as compared with low-oxygen concentration (RR, 1.31; 95% CI, 0.41–4.24). The quality of evidence was downgraded for serious imprecision. (Dawson 2009, F87) For the critical outcome of bronchopulmonary dysplasia, we found low-quality evidence from 5 randomized trials enrolling 502 subjects showing no benefit to beginning resuscitation with a high-oxygen as compared with low-oxygen concentration (RR, 1.08; 95% CI, 0.59–1.98). The quality of evidence was downgraded for inconsistency and imprecision. (Wang 2008, 1083; Vento 2009, e439; Rabi 2011, e374; Kapadia 2013, e1488; Rook 2014, 1322) For the critical outcome of intraventricular hemorrhage, we found moderate-quality evidence from 4 randomized clinical trials enrolling 400 subjects showing no benefit to beginning resuscitation with a high-oxygen as compared with low-oxygen concentration (RR, 0.90; 95% CI, 0.47–1.72). The quality of evidence was downgraded for imprecision.(Wang 2008, 1083; Vento 2009, e439; Kapadia 2013, e1488; Rook 2014, 1322) For the important outcome of retinopathy of prematurity, we found moderate-quality evidence from 3 randomized trials enrolling 359 subjects showing no benefit to beginning resuscitation with a high- as compared with low-oxygen concentration (RR, 1.28; 95% CI, 0.59–2.77). The quality of evidence was downgraded for imprecision. (Vento 2009, e439; Kapadia 2013, e1488; Rook 2014, 1322)
Treatment Recommendation:
We recommend against initiating resuscitation of preterm newborns (less than 35 weeks of gestation) with high supplementary oxygen concentrations (65%–100%). We recommend initiating resuscitation with a low-oxygen concentration (21%–30%) (strong recommendation, moderate-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we place value on not exposing preterm newborns to additional oxygen without proven benefit for critical or important outcomes. Our preference for each outcome, therefore, was to describe the risk of high-oxygen relative to low-oxygen concentration. In all studies, irrespective of whether air or high oxygen including 100% was used to initiate resuscitation, by the time of stabilization most infants were in approximately 30% oxygen. We recognize that all but 1 included study allowed adjustment of oxygen concentration based on pulse oximetry and/or heart rate response. Concerns were expressed about the practical implications of recommending separate and simultaneous monitoring of both heart rate and oxygen saturation, although accurate measurements of both variables are important (see NRP 898). The chosen range for the low oxygen starting point (21%–30%) was also questioned, but the available articles defined it. Whether the high oxygen should be greater than 60% was also discussed.
CoSTR Attachments:
Oxygen concentration for preterm GRADE recommendation grid 1 30 15.pdf    
Oxygen concentration for preterm SOF table 1 30 15.pdf    

 Contact Us

 
If you have any comments or questions on this page, please email us at: