Do We Know the Optimal Oxygen Concentration for Resuscitating a Premature Newborn?

Vasantha H.S. Kumar*

Do We Know the Optimal Oxygen Concentration for Resuscitating a Premature Newborn?

Recent studies and meta-analysis do not provide sufficient evidence to indicate that initiating resuscitation with lower oxygen concentration (≤30% O2) at birth decrease BPD or other clinical outcomes in premature neonates. On the other hand, it is of concern that, it may increase mortality particularly in infants <28 weeks gestational age with no demonstrable benefit on clinical outcomes. Did the pendulum swing too quickly from 100% O2 to 21% O2 for resuscitation of these infants? Should we initiate resuscitation of all premature infants with >21% O2, meaning a change in neonatal resuscitation guidelines or conduct a rigorous multicenter trial to address this dilemma.

Optimal management of oxygen during neonatal resuscitation has become particularly important, as insufficient or excessive oxygenation can be harmful to the newborn infant. In 2010, neonatal resuscitation program (NRP) issued guidelines for oxygen concentrations administered at birth based on nomograms for oxygen saturation targets in term and premature infants. Studies have
defined the percentiles of oxygen saturation (SpO2) as a function of time from birth in uncompromised babies born at term.2,3 The guidelines recommend that the goal in babies resuscitated at birth, whether born at term or preterm, should be an oxygen saturation value in the interquartile range of preductal saturations measured in healthy term babies following vaginal birth at sea level.

Furthermore, the guidelines recommend preductal SpO2 of 60-65% at 1 min; 65-70% at 2nd min; 70-75% at 3rd min; 75-80% at 4th min and 80-85% at the end of 5 minutes. Recommended SpO2
target from five to ten minutes after birth was 85-95%.1 The SpO2 guidelines were applicable for both term and premature infants, by initiating resuscitation with air or blended oxygen and titrating the oxygen concentration to obtain a SpO2 in the target range by pulse oximetry.

Pediatr Neonatal Nurs Open J. 2017; 5(1): 6-10. doi: 10.17140/PNNOJ-5-127