title: Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: a meta-analysis.
abstract: OBJECTIVE
  To systematically review outcomes of infants ≤28+6 weeks gestation randomised to resuscitation with low (≤0.3) vs high (≥0.6) fraction of inspired oxygen (FiO2) at delivery.
  
  
  METHODS
  Systematic review of randomised controlled trials of low (≤0.3) vs high (≥0.6) FiO2resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants ≤28+6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5.
  
  
  METHODS
  Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC).
  
  
  RESULTS
  A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04).
  
  
  CONCLUSIONS
  There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (≤0.30) or higher (≥0.6) FiO2in infants ≤28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies.
authors.affiliation: Department of Newborn Care, The Royal Hospital for Women, Randwick, New South Wales, Australia.|School of Women's and Children's Health, University of New South Wales, Randwick, New South Wales, Australia.|NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: Ju Lee
authors.initials: JL
authors.lastname: Oei
authors.affiliation: Division of Neonatology, University and Polytechnic Hospital La Fe, Valencia, Spain.
authors.forename: Maximo
authors.initials: M
authors.lastname: Vento
authors.affiliation: Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada.|Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
authors.forename: Yacov
authors.initials: Y
authors.lastname: Rabi
authors.affiliation: Illawarra Health and Medical Research Institute and Graduate School of Medicine, The University of Wollongong, Wollongong, New South Wales, Australia.
authors.forename: Ian
authors.initials: I
authors.lastname: Wright
authors.affiliation: Department of Pediatrics, Neonatology, University of California, San Diego, California, USA.|Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Finer
authors.affiliation: Sharp Mary Birch Hospital for Women and Newborns, San Diego, California, USA.
authors.forename: Wade
authors.initials: W
authors.lastname: Rich
authors.affiliation: Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center at Dallas, Dallas, Texas, USA.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kapadia
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
authors.forename: Dagfinn
authors.initials: D
authors.lastname: Aune
authors.affiliation: Division of Neonatology, Department of Pediatrics, Erasmus Medical Centre, Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Denise
authors.initials: D
authors.lastname: Rook
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Camperdown, New South Wales, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Tarnow-Mordi
authors.affiliation: Department of Pediatric Research, University of Oslo, Oslo University Hospital, Oslo, Norway.
authors.forename: Ola D
authors.initials: OD
authors.lastname: Saugstad
mesh_terms: D003696:Delivery Rooms; D004305:Dose-Response Relationship, Drug; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012151:Resuscitation / Q000379:methods*
chemical_list: D010100:Oxygen
keywords: Resuscitation; metaanalysis; oxygen; preterm