Neurodevelopmental outcomes of preterm infants after randomisation to initial resuscitation with lower (FiO2<0.3) or higher (FiO2>0.6) initial oxygen levels. An individual patient meta-analysis. Issue 4 (1st November 2021)

• Record Type: Journal Article
• Authors: Oei, Ju Lee; Kapadia, Vishal; Rabi, Yacov; Saugstad, Ola Didrik; Rook, Denise; Vermeulen, Marijn J; Boronat, Nuria; Thamrin, Valerie; Tarnow-Mordi, William; Smyth, John; Wright, Ian M; Lui, Kei; van Goudoever, Johannes B; Gebski, Val; Vento, Maximo
• Is Part Of: Archives of disease in childhood. Volume 107:Issue 4(2022)
• Page Start: 386
• Page End: 392
• Publication Date: 2021-11-01
• Subjects: neonatology -- resuscitation; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2021-321565
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objective: To determine the effects of lower (≤0.3) versus higher (≥0.6) initial fractional inspired oxygen (FiO2 ) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants &lt;32 weeks&#39; gestation. Design: Meta-analysis of individual patient data from three randomised controlled trials. Setting: Neonatal intensive care units. Patients: 543 children &lt;32 weeks&#39; gestation. Intervention: Randomisation at birth to resuscitation with lower (≤0.3) or higher (≥0.6) initial FiO2 . Outcome measures: Primary: death and/or NDI at 2 years of age. Secondary: post-hoc non-randomised observational analysis of death/NDI according to 5-minute oxygen saturation (SpO2 ) below or at/above 80%. Results: By 2 years of age, 46 of 543 (10%) children had died. Of the 497 survivors, 84 (17%) were lost to follow-up. Bayley Scale of Infant Development (third edition) assessments were conducted on 377 children. Initial FiO2 was not associated with difference in death and/or disability (difference (95% CI) −0.2%, −7% to 7%, p=0.96) or with cognitive scores &lt;85 (2%, −5% to 9%, p=0.5). Five-minute SpO2 &gt;80% was associated with decreased disability/death (14%, 7% to 21%) and cognitive scores &gt;85 (10%, 3% to 18%, p=0.01). Multinomial regression analysis noted decreased death with 5-minute SpO2 ≥80% (odds (95% CI) 09.62, 0.98 to 0.96) and gestation (0.52, 0.41 to 0.65), relative to children without death or NDI. Conclusion: Initial FiO2 was not associated with difference in risk of disability/death at 2 years in infants &lt;32 weeks&#39; gestation but CIs were wide. Substantial benefit or harm cannot be excluded. Larger randomised studies accounting for patient differences, for example, gestation and gender are urgently needed. Abstract : In an individual patient meta-analysis of infants less than 32 weeks gestation, resuscitation with lower (&lt;0.3) or higher (&gt;0.6) initial FiO2 was not associated with risk of death or disability at 2 years.