NEW YORK (Reuters Health) – Contrary to previous studies in term infants, preterm newborns requiring resuscitation do best when given 100% oxygen followed by frequent titration, rather than oxygen at room-air concentration.

That finding comes from a Canadian study, reported in the August issue of Pediatrics. The authors explain that room air has been shown to be better than 100% oxygen for resuscitating asphyxiated term and near-term newborns. However, evidence indicates that this may not be the best approach for preterm infants.

Dr. Yacov Rabi, at the University of Calgary, Alberta, and colleagues conducted a blinded randomized trial of three resuscitation strategies in 106 infants born at 32 weeks’ gestation or less, aimed at reaching and maintaining an oxygen saturation in the range of 85% to 92%.

The newborns were assigned to a high-oxygen group given a static concentration of 100% oxygen during assisted ventilation; or to a moderate-oxygen group, in which assisted ventilation started with 100% oxygen followed by frequent titration to achieve target oxygenation; or to a low-oxygen group receiving assisted ventilation starting at 21% oxygen with frequent adjustments also.

Time to reach target oxygenation was similar in the three groups. However, the team found, the mean proportion of time spent in the target oxymetry range was 11% in the high-oxygen group, 21% in the moderate-oxygen group, and 16% in the low-oxygen group

Rates of treatment failure, defined as a heart rate slower than 100 bpm for longer than 30 seconds, were 3%, 9%, and 24% in the three groups respectively, the report indicates.

Summing up, Dr. Rabi and colleagues conclude: “In our study, titrating from an initial oxygen concentration of 100% was more effective than starting with 21% oxygen or giving a static concentration of 100% oxygen for maintaining preterm infants in a target SPO2 range.”

They note that there is valid concern about oxidative injury with exposure to 100% oxygen in preterm infants. On the other hand, the authors advise, “We do not recommend using a static concentration of 21% oxygen for preterm resuscitation. This does not preclude starting resuscitation with an intermediate concentration of oxygen if an appropriate oxygen-titration schedule is used in conjunctionwith SPO2 monitoring.”

Reference:
Room-Air Versus Oxygen Administration for Resuscitation of Preterm Infants: The ROAR Study
Pediatrics 2011;128.