Ju Lee Oei1,2,3, Maximo Vento4, Yacov Rabi5,6, Ian Wright7, Neil Finer8,9, Wade Rich9, Vishal Kapadia10, Dagfinn Aune11, Denise Rook12, William Tarnow-Mordi3, Ola D Saugstad13. 1. Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia. 2. School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia. 3. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia. 4. Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain. 5. Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada. 6. Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada. 7. Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia. 8. Department of Pediatrics, Neonatology, University of California, San Diego, California, USA. 9. Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA. 10. Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA. 11. Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. 12. Division of Neonatology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands. 13. Department of Pediatric Research, University of Oslo, Oslo University Hospital, Oslo, Norway.
Abstract
OBJECTIVE: To systematically review outcomes of infants ≤28+6 weeks gestation randomised to resuscitation with low (≤0.3) vs high (≥0.6) fraction of inspired oxygen (FiO2) at delivery. DESIGN: Systematic review of randomised controlled trials of low (≤0.3) vs high (≥0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants ≤28+6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. MAIN OUTCOME MEASURES: Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). RESULTS: A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). CONCLUSIONS: There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (≤0.30) or higher (≥0.6) FiO2 in infants ≤28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
OBJECTIVE: To systematically review outcomes of infants ≤28+6 weeks gestation randomised to resuscitation with low (≤0.3) vs high (≥0.6) fraction of inspired oxygen (FiO2) at delivery. DESIGN: Systematic review of randomised controlled trials of low (≤0.3) vs high (≥0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants ≤28+6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5. MAIN OUTCOME MEASURES: Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). RESULTS: A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). CONCLUSIONS: There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (≤0.30) or higher (≥0.6) FiO2 in infants ≤28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Authors: Vishal S Kapadia; Charitharth V Lal; Venkat Kakkilaya; Roy Heyne; Rashmin C Savani; Myra H Wyckoff Journal: J Pediatr Date: 2017-12 Impact factor: 4.406
Authors: Elizabeth E Foglia; Benjamin Carper; Marie Gantz; Sara B DeMauro; Satyan Lakshminrusimha; Michele Walsh; Barbara Schmidt Journal: J Pediatr Date: 2019-04-05 Impact factor: 4.406
Authors: Kei Lui; Lisa J Jones; Jann P Foster; Peter G Davis; See Kwee Ching; Ju Lee Oei; David A Osborn Journal: Cochrane Database Syst Rev Date: 2018-05-04