Initial high oxygen concentration may reduce mortality in very preterm infants
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Key takeaways:
- High initial oxygen concentrations may be associated with reduced mortality in very preterm infants.
- Infants in the study were born at less than 32 weeks’ gestation.
High initial concentrations of lower fractional inspired oxygen may reduce mortality in very preterm infants, according to a study published in JAMA Pediatrics, although the researchers said their finding is not enough to change practice.
Resuscitation with lower fractional inspired oxygen (FiO2) reduces mortality in
term and near-term infants, but the impact of this practice on very preterm infants has been unclear, one of the authors of the new study told Healio.
“This research question really kicked off when there was evidence showing that using high concentrations of oxygen could cause damage through oxidative stress,” James X. Sotiropoulos, MD, junior doctor and PhD candidate at the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney, told Healio.
“In term infants, we knew that using room air, or 21% oxygen, was best. But then there was very little conclusive evidence in preterm infants, and particularly those most vulnerable preterm infants, which are less than 32 weeks’ gestational age,” Sotiropoulos said.
Sotiropoulos and colleagues systematically searched for randomized controlled trials that examined different initial oxygen concentrations to give to preterm infants when first born, restricting the age range to less than 32 weeks’ gestational age to ensure they were born very or extremely premature.
“With network meta-analysis, we were able to break these oxygen concentrations into three groups: low, intermediate and high,” Sotiropoulos said. “So, less than or equal to 30%, around 60%, and 90% to 100%, respectively.”
Among 1,055 infants included in 12 of the 13 eligible studies, resuscitation with high (0.9) initial FiO2 was associated with significantly reduced mortality, compared with low (OR = 0.45; 95% credible interval [CrI], 0.23-0.86; low certainty) and intermediate (OR = 0.34; 95% CrI, 0.11-0.99; very low certainty) concentrations of FiO2.
“We found there was a statistically significant reduction in all-cause mortality to hospital discharge when they were associated with higher concentrations of oxygen compared to lower concentrations of oxygen,” Sotiropoulos said. “It's in contrast to what's currently being done. Most clinical practice guidelines recommend using lower concentrations of oxygen to resuscitate infants.”
Sotiropoulos cautioned that the researchers were “not confident enough to say that we should go out and change clinical practice based on this evidence,” but said the use of high initial oxygen use should be reinvestigated.
“This new study gives us confidence to reinvestigate high initial oxygen as a possible therapeutic strategy moving forward,” Sotiropoulos said. “There's a few studies that are in the early stages of being planned and started up that are hopefully going to answer that question. I'm looking forward to seeing the results of those as well.”
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