Year: 2024
Type: article
Abstract: For decades neonatologists have grappled with defining the optimal approach to oxygenating preterm newborns in the delivery room.The case for term newborns is more clear: Since 2010, the International Liaison Committee on Resuscitation (ILCOR) has recommended initiating resuscitation with 0.21 fraction of inspired oxygen (FiO 2 ) rather than 1.0 FiO 2 (pure oxygen) due to increased mortality associated with exposure to pure oxygen.1,2 However, the "oxygen dilemma" persists for resuscitation of preterm infants.Most preterm infants require supplemental oxygen during postnatal transition, but they are also particularly vulnerable to oxidative injury to developing organs.3 Acknowledging this delicate balance, ILCOR recommends an initial low FiO 2 (0.21-0.30) for delivery room resuscitation of preterm infants.4 This recommendation was most recently informed by a 2019 systematic review and meta-analysis in which there was no statistically significant difference in short term mortality or morbidities between initial low versus higher FiO 2 for preterm infants.5 Authors of the ILCOR recommendations acknowledged the low certainty of available evidence, with no clear signal of benefit or harm for either approach.Existing treatment recommendations, therefore, reflect a consensus-driven preference to avoid exposing preterm newborns to additional oxygen in the absence of proven benefits.The practice of using an initial lower FiO 2 with subsequent titration to reach specified SpO 2 targets has been widely adopted internationally for resuscitation of preterm infants.
Authors: Alyssa R. Thomas, Elizabeth E. Foglia
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G5571840630
OpenAlex ID: W4400415736