use of high or low FiO_2 during initial resuscitation did not impact survival or neurodewelopmental outcomes of preterm infants: commentary

摘要

Paediatricians and neonatologists do not yet know whether they should start stabilising preterm infants in less or more oxygen, and this paper does little to change that. Two hundred and fifty-three babies were randomised in two trials, which seem to have been powered on measures of oxidative stress. Detailed 2-year follow-up shows no difference in their developmental attainment. However, this study is underpowered to exclude a difference in longer term functional and educational outcomes—in part because it is increasingly clear that outcomes at 2 years predict long-term function only imprecisely. What should we do when faced with a very preterm infant at birth? There are plenty of reasons to believe we should avoid using 100% oxygen. Current guidelines recommend starting with air, and titrating oxygen administration according to oxygen saturation ranges derived from well babies—most of whom were not preterm.12 However, these guidelines are not universally implemented—and a minority of clinicians still feel that using oximeters in delivery suite is inappropriate, even though they demonstrably provide a convenient measure of heart rate even then utility of saturation data is doubted.3 An important question, faced with a baby whose oxygen saturation is not 'normal', is whether increasing the oxygen or the level of breathing support or both or neither is the appropriate initial response.