Supplementary Material for: Air or oxygen for Infant Resuscitation (AIR): A prospective cohort study of moderate-late preterm infants requiring delivery room resuscitation

Background Due to concerns of oxidative stress and injury, most clinicians currently use lower levels of fractional inspired oxygen (FiO2, 0.21-0.3) to initiate respiratory support for moderate to late preterm (MLPT, 32-36 weeks’ gestation) infants at birth. Whether this practice achieves recommended oxygen saturation (SpO2) targets is unknown. Objectives To determine SpO2 trajectories of MLPT infants requiring respiratory support at birth. Design/Methods Prospective, opportunistic, observational study with consent waiver. Preductal SpO2 readings were obtained during the first 10 minutes of life from infants between 32-36 weeks’ gestation requiring respiratory support in the delivery room. Primary outcome was reaching a minimum SpO2 80% at 5 minutes of life. The study was prospectively registered (ACTRN12620001252909). Results A total of 76 eligible infants were recruited between February 2021 and March 2022 from 5 hospitals in Australia. Most (n=58, 76%) had respiratory support initiated with FiO2 0.21 (range 0.21-1.0) using CPAP (92%). Median SpO2 at 5 minutes was 81% (interquartile range [IQR] 67-90) and 93% (IQR 86-96) at 10 minutes. At 5 minutes, 18/43 (42%) infants had SpO2 below 80% and only 8/43 (19%) reached SpO2 80-85%. Conclusions Many MLPT infants requiring respiratory support do not achieve recommended SpO2 targets. In very preterm infants, SpO2 <80% at 5 minutes of life increases risk of death, intraventricular hemorrhage, and neurodevelopmental impairment. The implications on this practice on the health outcomes of MLPT infants is unclear and requires further research.