Low-Flow Oxygen for Positive Pressure Ventilation of Preterm Infants in the Delivery Room

Abstract

Background: The recent newborn resuscitation guidelines have recommended that a pulse oximeter and oxygen blender be used to keep oxygen saturation (SpO₂) within the target range. However, an oxygen blender and compressed air are not generally available in delivery rooms. Objectives: To determine whether using low-flow oxygen at 0.5-1 liters/min for positive pressure ventilation (PPV) via a self-inflating bag (SIB) without a reservoir is effective and able to maintain SpO₂ within the target range. Methods: Infants with a gestational age (GA) ≤32 weeks who initially required PPV after birth were enrolled. PPV was performed with low-flow oxygen at 0.5-1 liters/min via an SIB without a reservoir, and the flow was adjusted in a stepwise manner (from 0.5 to 0.8 to 1 liters/min) to keep SpO₂ in the target range. If the heart rate was still <100/min or SpO₂ was <70% at 3 min or chest compression was needed, then 100% oxygen was provided. Results: Forty-seven infants were enrolled in the study with a median (interquartile range) GA and birth weight of 28 (27-30) weeks and 1,060 (770-1,360) g, respectively. Twelve infants were initially intubated and switched to 100% oxygen (n = 12) due to ineffective ventilation, which occurred predominately in lower GA infants with intrapartum fetal distress. Thirty infants were successfully resuscitated with low-flow oxygen PPV (success rate 85.7%, 30/35), and >80% of their SpO₂ distribution during PPV was between the 3rd and 97th percentiles of the reference range. Conclusion: Low-flow oxygen for PPV via an SIB used in this study should be sufficient for providing oxygen in resuscitation of preterm infants as long as adequate ventilation is evident. This technique is simple and could be useful in a resource-limited setting.