title: Targeted Oxygen in the Resuscitation of Preterm Infants, a Randomized Clinical Trial.
abstract: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2on the combined risk of death and disability at 2 years in infants <32 weeks' gestation.
  
  
  
  A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission.
  
  
  
  Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants <28 weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%]; than those given 100% O2: 3 of 54 [6%]; risk ratio: 3.9 [95% confidence interval: 1.1-13.4]; P = .01). Respiratory failure was the most common cause of death (n = 13).
  
  
  
  Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.
authors.affiliation: School of Women's and Children's Health, the University of New South Wales, Australia; j.oei@unsw.edu.au.|Department of Newborn Care, Royal Hospital for Women, Australia.|Westmead International Network for Neonatal Education and Research, (WINNER Centre), NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: Ju Lee
authors.initials: JL
authors.lastname: Oei
authors.affiliation: Department of Pediatric Research, Olso University Hospital, University of Oslo, Oslo, Norway.
authors.forename: Ola D
authors.initials: OD
authors.lastname: Saugstad
authors.affiliation: School of Women's and Children's Health, the University of New South Wales, Australia.|Department of Newborn Care, Royal Hospital for Women, Australia.
authors.forename: Kei
authors.initials: K
authors.lastname: Lui
authors.affiliation: Illawarra Health and Medical Research Institute and Graduate Medicine, The University of Wollongong, Australia.|Hunter Medical Research Institute, University of Newcastle, Australia.|Department of Neonatology, John Hunter Hospital, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Wright
authors.affiliation: School of Women's and Children's Health, the University of New South Wales, Australia.|Department of Newborn Care, Royal Hospital for Women, Australia.
authors.forename: John P
authors.initials: JP
authors.lastname: Smyth
authors.affiliation: Department of Neonatology, John Hunter Hospital, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Craven
authors.affiliation: Faculty of Health, University of Technology Sydney, Australia.
authors.forename: Yueping Alex
authors.initials: YA
authors.lastname: Wang
authors.affiliation: Department of Neonatology, Royal Prince Alfred Hospital, Australia.
authors.forename: Rowena
authors.initials: R
authors.lastname: McMullan
authors.affiliation: Westmead International Network for Neonatal Education and Research, (WINNER Centre), NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Coates
authors.affiliation: School of Women's and Children's Health, the University of New South Wales, Australia.|Department of Newborn Care, Royal Hospital for Women, Australia.
authors.forename: Meredith
authors.initials: M
authors.lastname: Ward
authors.affiliation: School of Women's and Children's Health, the University of New South Wales, Australia.|Department of Newborn Care, Royal Hospital for Women, Australia.
authors.forename: Parag
authors.initials: P
authors.lastname: Mishra
authors.affiliation: Department of Neonatology, John Hunter Hospital, Australia.
authors.forename: Koert
authors.initials: K
authors.lastname: De Waal
authors.affiliation: Department of Neonatology, John Hunter Hospital, Australia.
authors.forename: Javeed
authors.initials: J
authors.lastname: Travadi
authors.affiliation: Sungai Buloh Hospital, Selangor, Malaysia.
authors.forename: Kwee Ching
authors.initials: KC
authors.lastname: See
authors.affiliation: Department of Paediatrics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
authors.forename: Irene G S
authors.initials: IG
authors.lastname: Cheah
authors.affiliation: Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Chin Theam
authors.initials: CT
authors.lastname: Lim
authors.affiliation: Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Yao Mun
authors.initials: YM
authors.lastname: Choo
authors.affiliation: Department of Paediatrics, University Malaya, Kuala Lumpur, Malaysia.
authors.forename: Azanna Ahmad
authors.initials: AA
authors.lastname: Kamar
authors.affiliation: Department of Paediatrics, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpar, Malaysia; and.
authors.forename: Fook Choe
authors.initials: FC
authors.lastname: Cheah
authors.affiliation: Hamad Medical Corporation, Qatar.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Masoud
authors.affiliation: Westmead International Network for Neonatal Education and Research, (WINNER Centre), NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Tarnow-Mordi
mesh_terms: D000388:Air; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D010092:Oximetry / Q000379:methods; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects / Q000379:methods*; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D012306:Risk