• Sonu Kumar, Mayank Priyadarshi, Poonam Singh, Suman Chaurasia, and Sriparna Basu.
• Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
• Resuscitation. 2025 Jan 1; 206: 110443110443.

RationaleThe ideal choice of initial fraction of inspired oxygen (FiO2) to stabilize preterm neonates in the delivery room (DR) is not well-established.ObjectiveTo compare the effects of different initial FiO2 in neonates < 34 weeks' gestation requiring respiratory support for DR stabilization.MethodsIn this open-labeled, assessor-blinded, parallel-group randomized controlled trial, 150 neonates were allocated to initiate DR-stabilization with 60 % (n = 75) versus 30 % (n = 75) FiO2, followed by titration to peripheral oxygen saturation (SpO2) targets. The primary outcome was the proportion of neonates achieving a target SpO2 of ≥ 80 % at 5 min of life. Secondary outcomes were minute-specific SpO2, heart rate (HR) and FiO2 trends till 10 min, regional cerebral oxygenation (CrSO2) at one hour, need for surfactant and caffeine, respiratory support duration, in-hospital adverse events, mortality, and duration of hospitalization. Stata 15 was used for an intention-to-treat analysis.ResultsThe proportion of neonates achieving SpO2 ≥ 80 % at 5 min was 58 (73.3 %) with 60 % compared to 38 (50.7 %) with 30 % FiO2 [relative risk (95 % confidence interval), 1.53 (1.18, 1.97); p < 0.001]. Though minute-specific SpO2 and FiO2 were significantly higher in the 60 % group, HR trends were comparable. No difference was observed in CrSO2, need and duration of respiratory support, surfactant, and caffeine, incidences of adverse events including mortality, and the duration of hospital stay.ConclusionA significantly higher number of preterm neonates < 34 weeks' gestation requiring DR stabilization achieved a 5-minute SpO2 of ≥ 80 % with higher minute-specific SpO2 trends when stabilized with an initial FiO2 of 60 % compared to 30 %.Copyright © 2024. Published by Elsevier B.V.

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