Insufficient evidence for low oxygen in preterm resuscitation

By Piriya Mahendra, medwireNews Reporter

Using low- rather than high-oxygen-concentration resuscitation gas for preterm infants cannot be recommended on the basis of available evidence, say researchers.

The meta-analysis of six randomized controlled trials found a statistically significant reduction in the risk ratio for mortality in infants treated with low-oxygen-concentration resuscitation gas, at 0.65, but this effect disappeared when only four trials with adequate allocation concealment were included.

"This finding emphasizes the potential contribution of methodological design issues, particularly lack of allocation concealment, to systematic bias in trials and meta-analyses," write William McGuire (University of York, UK) and team in PLoS One.

The authors say that the existing trial data were insufficient to determine how using lower versus higher oxygen concentrations for delivery room respiratory support affects important outcomes for preterm infants.

"Although the overall pooled estimate suggests that using lower concentrations of oxygen reduces mortality, this is likely to be an overestimate of effect size due to allocation bias in quasi-randomised trials," remark the authors.

"Further large, good-quality randomised controlled trials are needed to resolve this uncertainty."

The majority of the trials included in the study used room air (21% oxygen) as the low-oxygen-concentration resuscitation gas. The most commonly used high-oxygen-concentration gas for resuscitation was 100%. Individually, none of the trials found a statistically significant difference between low and high oxygen concentration resuscitation gas.

McGuire et al say that future trials "should assess different strategies based on the clinical setting." They note that in high-resource settings, it is likely that clinicians will use pulse oximetry to titrate oxygen administration from either a lower or higher starting point using an oxygen blender.

In low-resource settings, however, where pulse oximetry or oxygen blender technology is not readily available, the researchers recommend that clinicians undertake a pragmatic trial of set concentrations (air versus 100% oxygen).

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