Initial Oxygen Concentration for Preterm Newborn Resuscitation

Insights

Past Red Cross guidelines for resuscitation of preterm newborns less than 35+0 weeks’ gestation suggested using an initial oxygen concentration between 21% and 30% and titration based on pulse oximetry. A recent individual patient network meta-analysis of infants less than 32 weeks’ gestation suggested lower mortality with higher compared with lower initial fraction of inspired oxygen (FiO₂). For other outcomes, such as severe intraventricular hemorrhage, the evidence could not exclude either benefit or harm. A separate meta-analysis that included infants less than 35 weeks’ gestation was unable to exclude a clinical benefit or harm with use of a lower initial oxygen concentration (FiO₂ ≤9.6) compared with a higher initial oxygen concentration (FiO₂ >0.5). An updated Red Cross guideline suggests that for preterm infants born at less than 32 weeks’ gestation requiring resuscitation, it is reasonable to initiate resuscitation with a an FiO₂ of 0.30 or more and titrate using pulse oximetry. For preterm newborns at 32 to 34 +6 weeks’ gestation, no new evidence of harm with lower oxygen concentrations has emerged; therefore, the Red Cross maintains its previous guidance for infants born at 32+0 to 35 weeks’ gestation to begin resuscitation with an oxygen concentration between 21% and 30%, followed by titration per pulse oximetry.