Supplemental oxygen for preterm infants in the delivery room

Abstract

The generous provision of oxygen in the delivery room was a central tenet of neonatal resuscitation until recent studies demonstrated potential harm from the use of 100% oxygen. Recent recommendations are to use oxygen blenders and oxygen saturation monitors to titrate the oxygen needs for the individual patient. The provision of compressed air, oxygen, a blender, and a pulse oximeter for each delivery room is a substantial burden for hospitals and certainly is not available in low-resource environments where deliveries occur. However, for facilities delivering very low-birth weight preterm infants, the ability to titrate oxygen use to need is now standard of care. We know from a number of trials that 100% oxygen is seldom required for term or preterm infants. Other trials demonstrate that room air often is inadequate for preterm infants. In this issue of The Journal, Rook et al report that initial oxygen concentrations of either 30% or 65% were equivalent for initial respiratory support of infants with mean birth weights of about 1kg. With the use of pulse oximeters to adjust oxygen need, both groups achieved comparable saturations with about 40% oxygen by 5 minutes of age. There were no differences in oxidant stress markers or clinical outcomes. Because this population of infants on average required 40% oxygen, perhaps a compromise would be to begin respiratory support of very low-birth weight infants with 40% oxygen and adjust individual needs with an oximeter. Article page 1322▶ Resuscitation of Preterm Infants with Different Inspired Oxygen FractionsThe Journal of PediatricsVol. 164Issue 6PreviewTo test the hypothesis that an initial fraction of inspired oxygen (FiO2) of 30% during resuscitation of preterm infants results in less oxidative stress and is associated with improved clinical outcomes compared with an FiO2 of 65%. Full-Text PDF