Oxygen for the delivery room respiratory support of moderate-to-late preterm infants. An international survey of clinical practice from 21 countries

Abstract

Aim: The aim of this study was to determine clinician opinion regarding oxygen management in moderate-late preterm resuscitation.

Methods: An anonymous online questionnaire was distributed through email/social messaging platforms to neonatologists in 21 countries (October 2020-March 2021) via REDCap.

Results: Of the 695 respondents, 69% had access to oxygen blenders and 90% had pulse oximeters. Respondents from high-income countries were more likely to have oxygen blenders than those from middle-income countries (72% vs. 66%). Most initiated respiratory support with FiO₂ 0.21 (43%) or 0.3 (36%) but only 45% titrated FiO₂ to target SpO₂ . Most (89%) considered heart rate as a more important indicator of response than SpO₂ . Almost all (96%) supported the need for well-designed trials to examine oxygenation in moderate-late preterm resuscitation.

Conclusion: Most clinicians resuscitated moderate-late preterm infants with lower initial FiO₂ but some cannot/will not target SpO₂ or titrate FiO₂ . Most consider heart rate as a more important indicator of infant response than SpO₂ .Large and robust clinical trials examining oxygen use for moderate-late preterm resuscitation, including long-term neurodevelopmental outcomes, are supported amongst clinicians.

Keywords: delivery room practice; moderate-late preterm infant; neonatal resuscitation; oxygen concentration; oxygen saturation.