A review of international clinical practice guidelines for the use of oxygen in the delivery room resuscitation of preterm infants

作者：Wilson A; Vento M; Shah P S; Saugstad O; Finer N; Rich W; Morton R L; Rabi Y; Tarnow Mordi W; Suzuki K; Wright I M; Oei J L

来源：Acta Paediatrica, 2018, 107(1): 20-27.

DOI：10.1111/apa.14012

• Clinical practice guidelines
• Oxygen
• Preterm and resuscitation

AimTo collate and assess international clinical practice guidelines (CPG) to determine current recommendations guiding oxygen management for respiratory stabilisation of preterm infants at delivery.
MethodsA search of public databases using the terms clinical practice guidelines', preterm', oxygen' and resuscitation' was made and complemented by direct query to consensus groups, resuscitation expert committees and clinicians. Data were extracted to include the three criteria for assessment: country of origin, gestation and initial FiO(2) and target SpO(2) for the first 10 minutes of life.
ResultsA total of 45 CPGs were identified: 36 provided gestation specific recommendations (<28 to <37 weeks) while eight distinguished only between preterm' and term'. The most frequently recommended initial FiO(2) were between 0.21 and 0.3 (n = 17). Most countries suggested altering FiO(2) to meet SpO(2) targets recommended by expert committees, However, specific five-minute SpO(2) targets differed by up to 20% (70-90%) between guidelines. Five countries did not specify SpO(2) targets.
ConclusionCPG recommendations for delivery room oxygen management of preterm infants vary greatly, particularly in regard to gestational ages, initial FiO(2) and SpO(2) targets and most acknowledge the lack of evidence behind these recommendations. Sufficiently large and well-designed randomised studies are needed to inform on this important practice.

• 出版日期2018-1