Overview
Since 2010, the International Liaison Committee on Resuscitation (ILCOR) guidelines has recommended air or “less oxygen” as the initial oxygen concentrations for preterm infants requiring resuscitation. In addition, the guidelines state that oxygen should be titrated during resuscitation to meet peripheral oxygen saturation (SpO2) target ranges, which correspond to those of spontaneously breathing, healthy full-term infants. In 2019, ILCOR performed an updated meta-analysis using the GRADE approach and reported very low certainty of evidence for all outcomes. The comparison between initial lower (<30%) or higher (>65%) oxygen for preterm newborns <35 weeks’ gestation who receive respiratory support at birth demonstrated no consistent evidence to define the ideal initial oxygen concentration and the current recommendation remains to use lower oxygen concentrations. Further studies are needed to determine if a low 5-minute SpO2 is a significant predictor of poor neonatal outcomes including death and/or severe intraventricular hemorrhage (IVH).
CPQCC has launched a delivery room oxygen data collection pilot to improve understanding of this issue. By collecting data on mean oxygen saturation (SaO2) and inspired oxygen concentration (FiO2) at 5 minutes after delivery for inborn infants <1500 grams or <32 weeks, we aim to examine the current practice of initial oxygen concentration levels for preterm infants and the effect on long-term neurodevelopmental outcomes. These two variables will be the only supplemental questions that are required for the pilot study.
The Delivery Room Oxygen Data Collection Pilot is being overseen by the PQIP Research committee and is being led by co-chairs Anup Katheria and Henry Lee.
Data Items
Mean Oxygen Saturation (SaO2) at 5 Minutes
The infant's average oxygen saturation (SaO2) as a percentage ranging from 0% to 100% at 5 minutes as noted in the Labor and Delivery record, if available.
Inspired Oxygen Concentration (FiO2) at 5 Minutes
The infant's inspired oxygen concentration (FiO2) ranging from 21% to 100% at 5 minutes as noted in the Labor and Delivery record, if available.