Background

For infants born at full term, the use of air (21% oxygen) for resuscitation is generally well tolerated and may be associated with better outcomes. Infants born preterm (before 37 weeks’ gestation) require more resuscitation after birth and have more problems with adaptation to life.

Review question

This review set out to investigate whether the use of lower or higher concentrations of oxygen (adjusted according to the infant’s oxygen saturation, or percentage of hemoglobin binding sites in the bloodstream occupied by oxygen) are better for resuscitating preterm infants, when used in the first ten minutes after birth.

Results

We included ten trials in this review. The trials included a total of 914 infants, the majority of which were born before 32 weeks’ gestation. The review found no evidence of an effect from use of a lower compared to a higher initial oxygen concentration targeted to infant oxygen saturation for resuscitation on mortality or other newborn health outcomes. There was also no difference in the rate of airway intubation (placement of a flexible plastic tube into the windpipe) during resuscitation between the infants who received lower concentrations of oxygen and those who received higher concentrations of oxygen. There was not enough information to determine the effect on long-term outcomes including neurodevelopmental disability (impairment in physical, learning, language, or behaviour areas). We judged the overall quality of the evidence to be low because of the uncertainty of the effects we found and also because we had concerns about the way in which many of the studies were carried out. The evidence in this review is current to October 2017.

Conclusions

When targeted to the infant’s oxygen saturation, it is currently unclear whether the initial oxygen concentration used for resuscitation of preterm infants affects short- or long-term infant outcomes. Further trials enrolling preterm infants at birth assessing both the initial oxygen concentration and the best level of oxygen saturation to target are needed.