Initial Oxygen Use for Preterm Newborn Resuscitation: A Systematic Review With Meta-analysis

Area of Science:

• Neonatal Resuscitation
• Perinatal Medicine
• Pediatric Critical Care

Background:

• The International Liaison Committee on Resuscitation identified a need to review initial oxygen concentrations during preterm newborn resuscitation.
• Determining optimal initial fraction of inspired oxygen (Fio2) is critical for improving outcomes in vulnerable preterm infants.

Purpose of the Study:

• To systematically review and meta-analyze the scientific evidence on initial Fio2 use in preterm newborns (<35 weeks' gestation) receiving respiratory support at birth.

Main Methods:

• A comprehensive search of multiple databases (Medline, Embase, etc.) was conducted from 1980 to 2018.
• Ten randomized controlled trials and 4 cohort studies, involving 5697 infants, were included.
• Data extraction, risk of bias assessment, and certainty of evidence evaluation were performed by independent reviewers.

Main Results:

• No statistically significant differences in short-term mortality were observed between lower and higher initial Fio2 groups (n=968; RR 0.83 [0.50-1.37]).
• No significant benefits or harms were found regarding long-term mortality, neurodevelopmental impairment, or other preterm morbidities.
• A sensitivity analysis excluding a high-risk-of-bias study also showed no mortality reduction with lower initial Fio2.

Conclusions:

• The optimal initial fraction of inspired oxygen (Fio2) for preterm newborns is currently undetermined.
• While the ideal concentration is unknown, most infants ≤32 weeks' gestation will necessitate oxygen supplementation.
• The certainty of evidence for all outcomes was very low due to risk of bias, inconsistency, and imprecision.