title: Room-air versus oxygen administration for resuscitation of preterm infants: the ROAR study.
abstract: OBJECTIVE
  We conducted a blinded, prospective, randomized control trial to determine which oxygen-titration strategy was most effective at achieving and maintaining oxygen saturations of 85% to 92% during delivery-room resuscitation.
  
  
  METHODS
  Infants born at 32 weeks' gestation or less were resuscitated either with a static concentration of 100% oxygen (high-oxygen group) or using an oxygen-titration strategy starting from a concentration of 100% (moderate-oxygen group), or 21% oxygen (low-oxygen group). In the moderate- and low-oxygen groups, the oxygen concentration was adjusted by 20% every 15 seconds to reach a target oxygen saturation range of 85% to 92%. Treatment failure was defined as a heart rate slower than 100 beats per minute for longer than 30 seconds.
  
  
  RESULTS
  The moderate-oxygen group spent a greater proportion of time in the target oxygen saturation range (mean: 0.21 [95% confidence interval: 0.16-0.26]) than the high-oxygen group (mean: 0.11 [95% confidence interval: 0.09-0.14]). Infants in the low-oxygen group were 8 times more likely to meet the criteria for treatment failure than those in the high-oxygen group (24% vs 3%; P = .022). The 3 groups did not differ significantly in the time to reach the target oxygen saturation range.
  
  
  CONCLUSIONS
  Titrating from an initial oxygen concentration of 100% was more effective than giving a static concentration of 100% oxygen in maintaining preterm infants in a target oxygen saturation range. Initiating resuscitation with 21% oxygen resulted in a high treatment-failure rate.
authors: Division of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada. jack.rabi@albertahealthservices.ca
authors: Yacov
authors: Y
authors: Rabi
authors: Nalini
authors: N
authors: Singhal
authors: Alberto
authors: A
authors: Nettel-Aguirre
mesh_terms: D000388:Air; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D016037:Single-Blind Method; D017211:Treatment Failure
chemical_list: D010100:Oxygen