High Initial fractional inspired oxygen May Reduce Mortality in Preterm Infants, reveals study

The primary outcome was all-cause mortality at hospital discharge. Secondary outcomes included morbidities associated with prematurity and SpO2 levels at 5 minutes post-resuscitation.

• Data were obtained for 1055 infants from 12 of the 13 eligible studies conducted between 2005 and 2019.

• The findings revealed that resuscitation with high initial FiO2 (≥0.90) was associated with significantly reduced mortality compared to both low (≤0.3) FiO2 (odds ratio [OR], 0.45; 95% credible interval [CrI], 0.23-0.86; low certainty) and intermediate (0.5-0.65) FiO2 (OR, 0.34; 95% CrI, 0.11-0.99; very low certainty).

• High initial FiO2 had a 97% probability of ranking first in reducing mortality. However, the effects on other morbidities were inconclusive.

These results suggest that a high initial FiO2 (≥0.90) may be more effective in reducing mortality in preterm infants born at less than 32 weeks' gestation compared to lower FiO2 levels. While the certainty of these findings varies, the data supports the consideration of higher FiO2 levels during resuscitation in this vulnerable population.

High initial FiO2 (≥0.90) may significantly reduce mortality in preterm infants born before 32 weeks' gestation compared to low initial FiO2, albeit with low certainty. The potential advantage of high FiO2 over intermediate FiO2 is suggested but requires further evidence. These findings could influence resuscitation protocols to improve outcomes for preterm infants.

Reference:

Sotiropoulos, J. X., Oei, J. L., Schmölzer, G. M., Libesman, S., Hunter, K. E., Williams, J. G., Webster, A. C., Vento, M., Kapadia, V., Rabi, Y., Dekker, J., Vermeulen, M. J., Sundaram, V., Kumar, P., Kaban, R. K., Rohsiswatmo, R., Saugstad, O. D., & Seidler, A. L. (2024). Initial oxygen concentration for the resuscitation of infants born at less than 32 weeks’ gestation: A systematic review and individual participant data network meta-analysis. JAMA Pediatrics. https://doi.org/10.1001/jamapediatrics.2024.1848