Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants

Objective To determine the association between SpO 2 at 5 min and preterm infant outcomes. Design Data from 768 infants <32 weeks gestation from 8 randomised controlled trials (RCTs) of lower (≤0.3) versus higher (≥0.6) initial inspiratory fractions of oxygen (FiO 2) for resuscitation, were examined. Setting Individual patient analysis of 8 RCTs Interventions Lower (≤0.3) versus higher (≥0.6) oxygen resuscitation strategies targeted to specific predefined SpO 2 before 10 min of age. Patients Infants <32 weeks gestation. Main outcome measures Relationship between SpO 2 at 5 min, death and intraventricular haemorrhage (IVH) >grade 3. Results 5 min SpO 2 data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO 2 study targets and 323 (46%) did not reach SpO 2 80%. Pooled data showed decreased likelihood of reaching SpO 2 80% if resuscitation was initiated with FiO 2 <0.3 (OR 2.63, 95% CI 1.21 to 5.74, p<0.05). SpO 2 <80% was associated with lower heart rates (mean difference -8.37, 95% CI -15.73 to -1.01, ∗p<0.05) and after accounting for confounders, with IVH (OR 2.04, 95% CI 1.01 to 4.11, p<0.05). Bradycardia (heart rate <100 bpm) at 5 min increased risk of death (OR 4.57, 95% CI 1.62 to 13.98, p<0.05). Taking into account confounders including gestation, birth weight and 5 min bradycardia, risk of death was significantly increased with time taken to reach SpO 2 80%. Conclusion Not reaching SpO 2 80% at 5 min is associated with adverse outcomes, including IVH. Whether this is because of infant illness or the amount of oxygen that is administered during stabilisation is uncertain and needs to be examined in randomised trials.