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Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks' Gestation: A Systematic Review and Individual Participant Data Network Meta-Analysis.
Sotiropoulos, James X; Oei, Ju Lee; Schmölzer, Georg M; Libesman, Sol; Hunter, Kylie E; Williams, Jonathan G; Webster, Angela C; Vento, Maximo; Kapadia, Vishal; Rabi, Yacov; Dekker, Janneke; Vermeulen, Marijn J; Sundaram, Venkataseshan; Kumar, Praveen; Kaban, Risma K; Rohsiswatmo, Rinawati; Saugstad, Ola D; Seidler, Anna Lene.
Afiliación
  • Sotiropoulos JX; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
  • Oei JL; School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Schmölzer GM; Department of Newborn Care, the Royal Hospital for Women, Randwick, New South Wales, Australia.
  • Libesman S; School of Women's and Children's Health, Faculty of Medicine and Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Hunter KE; Department of Newborn Care, the Royal Hospital for Women, Randwick, New South Wales, Australia.
  • Williams JG; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
  • Webster AC; Centre for the Studies of Asphyxia and Resuscitation, Neonatology, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
  • Vento M; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
  • Kapadia V; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
  • Rabi Y; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
  • Dekker J; National Health and Medical Research Council Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
  • Vermeulen MJ; University and Polytechnic Hospital La Fe, Valencia, Spain.
  • Sundaram V; Health Research Institute La Fe, Valencia, Spain.
  • Kumar P; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas.
  • Kaban RK; Department of Pediatrics, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
  • Rohsiswatmo R; Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, Leiden, the Netherlands.
  • Saugstad OD; Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus Medical Center, Rotterdam, the Netherlands.
  • Seidler AL; Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
JAMA Pediatr ; 178(8): 774-783, 2024 Aug 01.
Article en En | MEDLINE | ID: mdl-38913382
ABSTRACT
Importance Resuscitation with lower fractional inspired oxygen (FiO2) reduces mortality in term and near-term infants but the impact of this practice on very preterm infants is unclear.

Objective:

To evaluate the relative effectiveness of initial FiO2 on reducing mortality, severe morbidities, and oxygen saturations (SpO2) in preterm infants born at less than 32 weeks' gestation using network meta-analysis (NMA) of individual participant data (IPD). Data Sources MEDLINE, Embase, CENTRAL, CINAHL, ClinicalTrials.gov, and WHO ICTRP from 1980 to October 10, 2023. Study Selection Eligible studies were randomized clinical trials enrolling infants born at less than 32 weeks' gestation comparing at least 2 initial oxygen concentrations for delivery room resuscitation, defined as either low (≤0.3), intermediate (0.5-0.65), or high (≥0.90) FiO2. Data Extraction and

Synthesis:

Investigators from eligible studies were invited to provide IPD. Data were processed and checked for quality and integrity. One-stage contrast-based bayesian IPD-NMA was performed with noninformative priors and random effects and adjusted for key covariates. Main Outcomes and

Measures:

The primary outcome was all-cause mortality at hospital discharge. Secondary outcomes were morbidities of prematurity and SpO2 at 5 minutes.

Results:

IPD were provided for 1055 infants from 12 of the 13 eligible studies (2005-2019). Resuscitation with high (≥0.90) initial FiO2 was associated with significantly reduced mortality compared to low (≤0.3) (odds ratio [OR], 0.45; 95% credible interval [CrI], 0.23-0.86; low certainty) and intermediate (0.5-0.65) FiO2 (OR, 0.34; 95% CrI, 0.11-0.99; very low certainty). High initial FiO2 had a 97% probability of ranking first to reduce mortality. The effects on other morbidities were inconclusive. Conclusions and Relevance High initial FiO2 (≥0.90) may be associated with reduced mortality in preterm infants born at less than 32 weeks' gestation compared to low initial FiO2 (low certainty). High initial FiO2 is possibly associated with reduced mortality compared to intermediate initial FiO2 (very low certainty) but more evidence is required.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oxígeno / Terapia por Inhalación de Oxígeno / Resucitación / Metaanálisis en Red Límite: Humans / Newborn Idioma: En Revista: JAMA Pediatr Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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XML
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Oxígeno / Terapia por Inhalación de Oxígeno / Resucitación / Metaanálisis en Red Límite: Humans / Newborn Idioma: En Revista: JAMA Pediatr Año: 2024 Tipo del documento: Article País de afiliación: Australia Pais de publicación: Estados Unidos