Air or oxygen for infant resuscitation: a prospective cohort study of moderate-late preterm infants requiring delivery room resuscitation

Introduction: Due to concerns of oxidative stress and injury, most clinicians currently use lower levels of fractional inspired oxygen (FiO₂, 0.21 0.3) to initiate respiratory support for moderate to late preterm (MLPT, 32 36 weeks gestation) infants at birth. Whether this practice achieves recommended oxygen saturation (SpO₂) targets is unknown. Methods: We aimed to determine SpO₂ trajectories of MLPT infants requiring respiratory support at birth. We conducted a prospective, opportunistic, observational study with consent waiver. Preductal SpO₂ readings were obtained during the first 10 min of life from infants between 32 and 36 weeks gestation requiring respiratory support in the delivery room. Primary outcome was reaching a minimum SpO₂ 80% at 5 min of life. The study was prospectively registered (ACTRN12620001252909). Results: A total of 76 eligible infants were recruited between February 2021 and March 2022 from 5 hospitals in Australia. Most (n = 58, 76%) had respiratory support initiated with FiO2 0.21 (range 0.21 1.0) using CPAP (92%). Median SpO₂ at 5 min was 81% (interquartile range [IQR] 67 90) and 93% (IQR 86 96) at 10 min. At 5 min, 18/43 (42%) infants had SpO₂ below 80% and only 8/43 (19%) reached SpO2 80 85%. Conclusions: Many MLPT infants requiring respiratory support do not achieve recommended SpO2 targets. In very preterm infants, SpO₂ <80% at 5 min of life increases risk of death, intraventricular haemorrhage, and neurodevelopmental impairment. The implications on this practice on the health outcomes of MLPT infants are unclear and require further research.