Oxygen and preterm infant resuscitation: what else do we need to know?

Area of Science:

• Neonatal resuscitation
• Pediatric critical care
• Respiratory support

Background:

• The optimal oxygen strategy for preterm infant resuscitation remains debated.
• Recent meta-analyses have shifted the clinical equipoise regarding higher fraction of inspired oxygen (FiO2) use.

Purpose of the Study:

• To evaluate current evidence comparing lower versus higher oxygen concentrations for preterm infant resuscitation.
• To identify outcomes associated with different oxygen strategies and highlight knowledge gaps.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials comparing high (≥0.6) versus low (≤0.3) FiO2 for preterm resuscitation.
• Analysis of infant death, major morbidities, heart rate, and intraventricular hemorrhage rates.

Main Results:

• No significant difference in death or major morbidities between higher and lower initial FiO2 strategies.
• Failure to achieve pulse oximetry saturation ≥80% by 5 minutes was linked to lower heart rates and increased major intraventricular hemorrhage.
• Limited data exists on neurodevelopmental outcomes and impact in low-resource settings.

Conclusions:

• Lower oxygen strategies are increasingly adopted, but evidence does not show a difference in major outcomes compared to higher FiO2.
• Ensuring adequate oxygenation to meet saturation targets is critical to prevent adverse events in preterm infants.
• Further research is needed on neurodevelopmental outcomes and strategies in resource-limited environments.