Giving very premature babies high concentrations of oxygen soon after birth may reduce the risk of death by 50 percent, compared to lower levels of oxygen says new research led by University of Sydney researchers.
When premature babies are born, they sometimes need help breathing because their lungs haven’t finished developing. To assist babies during this process, doctors may provide them with extra oxygen through a breathing mask or breathing tube.
The study, published in JAMA Pediatrics, examined clinical trial data and outcomes of over one thousand premature babies who were given different oxygen concentrations. This included low concentrations of oxygen (~30 percent), intermediate (~50-65 percent) or high (~90 percent).
The research found that for babies born prematurely, at less than 32 weeks (less than three quarters of the way through a full pregnancy), starting resuscitation with high concentrations of oxygen (90 percent or greater), could increase chances of survival compared to low levels (21 to 30 percent).
For comparison, the air we breathe, also known as ‘room air’ only has about 21 percent oxygen.
Doctors use a device to regulate the mixture of oxygen provided to babies needing breathing assistance to reach the desired concentration. The researchers suggest that higher initial levels of oxygen may help kickstart independent breathing, but more research is needed to explore the underlying cause for this effect.
The researchers stress the importance of additional large studies to validate this finding, and caution that even when starting with high oxygen, it should be adjusted to lower levels swiftly to avoid hyperoxia (oxygen poisoning).
Delivery of oxygen during the first 10 minutes of an infant’s life is crucial. Doctors may administer high levels of oxygen initially but then continuously monitor vital signs and adjust the oxygen levels to prevent over or underexposure.
If confirmed in future studies, the results challenge current international recommendations that suggest providing preterm babies with the same amount of oxygen as term babies, which is 21 percent to 30 percent oxygen (room air), instead of extra oxygen.
This study highlights that there may not be a one-size-fits-all approach, and babies born prematurely may have different needs than babies born at term.
Across the globe, over 13 million babies are born prematurely each year, with nearly 1 million dying shortly after birth.
“Ensuring very premature infants receive the appropriate treatment from the beginning sets them up for healthy lives. There is no better time to intervene than right after birth,” said lead author Dr. James Sotiropoulos from the University of Sydney’s NHMRC Clinical Trials Centre.
“The goal is to find the right balance — how do we provide enough oxygen to prevent death and disability, but avoid damaging vital organs.”
“While promising and potentially practice-changing, these findings will need to be confirmed in future larger studies.”
Traditionally, a 100 percent oxygen concentration was used to resuscitate all newborn infants. However, due to studies showing that high oxygen concentrations over time can lead to hyperoxia and subsequent organ damage, changes were made in international treatment recommendations in 2010 for using blended oxygen (starting with low oxygen) for preterm infants.
Nevertheless, researchers note that the change was primarily based on evidence for full-term infants, who have fully developed lungs and are often not as sick as premature infants.
Currently, there is limited conclusive evidence to guide best practices for premature infants.
The researchers stress that the findings should not downplay the risks of hyperoxia.
“The discussion around the optimal oxygen levels for extremely premature babies is ongoing, but ultimately, everyone shares the common goal of determining the best treatment for newborns,” said Dr. Anna Lene Seidler from the NHMRC Clinical Trials Centre.
“Our findings, along with the ongoing research in this area, may help the most vulnerable preterm infants have the best chance of survival.”
“We are fortunate to collaborate with a highly cohesive international group on this question, some of whom have been studying it for decades. The diverse expertise and experience of the group are key strengths of this work,” added Dr. Sotiropoulos.
