Elsevier

The Journal of Pediatrics

Volume 191, December 2017, Pages 35-41
The Journal of Pediatrics

Original Articles
Impact of the Neonatal Resuscitation Program–Recommended Low Oxygen Strategy on Outcomes of Infants Born Preterm

https://doi.org/10.1016/j.jpeds.2017.08.074Get rights and content

Objective

To evaluate the impact of the Neonatal Resuscitation Program (NRP)-recommended low oxygen strategy (LOX) on neonatal morbidities, mortality, and neurodevelopmental outcomes in neonates born preterm.

Study design

In March 2011, Parkland Hospital changed from a high oxygen strategy (HOX) of resuscitation with initial 100% oxygen and targeting 85%-94% oxygen saturation for delivery room resuscitation to a LOX with initial 21% oxygen and titrating oxygen to meet NRP-recommended transitional target saturations. Neonates ≤28 weeks' gestational age born between August 2009 and April 2012 were identified. In this retrospective, observational study, neonates exposed to LOX vs HOX were compared for short-term morbidity, mortality, and long-term neurodevelopmental outcomes. Regression analysis was performed to control for confounding variables.

Results

Of 199 neonates, 110 were resuscitated with HOX and 89 with LOX. Compared with HOX, neonates exposed to LOX had lower oxygen exposure in the delivery room (5.2 ± 1.5 vs 7.8 ± 2.8 [∑FiO2 × time min], P < .01), spent fewer days on oxygen (30 [5, 54] vs 46 [11, 82], P = .01), and had lower odds of developing bronchopulmonary dysplasia (aOR 0.4 [0.2, 0.9]). There was no difference in mortality (17 [20%] vs 20 [18%]), but neonates exposed to LOX had greater motor composite scores on Bayley Scales of Infant and Toddler Development–Third edition assessment (91 [85, 97] vs 88 [76, 94], P < .01).

Conclusion

The NRP-recommended LOX strategy was associated with improved respiratory morbidities and neurodevelopmental outcomes with no increase in mortality. Prospective trials to confirm the optimal oxygen strategy for the resuscitation of neonates born preterm are needed.

Section snippets

Methods

A retrospective cohort study was conducted to examine neonates born preterm at ≤28 weeks' gestational age (GA) between August 2009 and April 2012 at Parkland Hospital, Dallas, Texas. The study was approved by University of Texas Southwestern Medical Center institutional review board.

At Parkland Hospital before March 2011, in compliance with the 2006 NRP guidelines,22 neonates born preterm were resuscitated in the delivery room with a high oxygen strategy (HOX) where stabilization was initiated

Results

During the study period, 255 neonates were born at 23-28 weeks' GA (Figure). After we excluded neonates who received only comfort care at the request of their family and those who were enrolled in a delivery room randomized control trial of different oxygen strategies,8 199 neonates were included in the study. Of these, 89 were resuscitated with LOX and 110 were resuscitated with HOX. After we accounted for mortality before neurodevelopmental assessment and loss to follow-up, 87% of the study

Discussion

This study demonstrates that neonates born preterm resuscitated with the NRP-recommended LOX strategy were exposed to lower oxygen load in the delivery room, had fewer days on oxygen in the NICU, and had a lower incidence of BPD, even after we adjusted for confounding variables. Infants resuscitated with LOX also had no increase in mortality and had greater Bayley III motor composite scores at 2-year follow-up.

It is possible that the reduced oxygen load in the delivery room resulted in a lower

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    Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health 1K23HD083511-01A1 (to V.K.). The authors declare no conflicts of interest.

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