TARGETED OXYGEN (60 PERCENT vs 30 PERCENT) FOR RESUSCITATION IN PRETERM NEONATES BETWEEN 26-32 WEEKS OF GESTATIONAL AGE: A RANDOMIZED CONTROL TRIAL

Newborn resuscitation requires anticipation and preparation. It has been proven that term and late preterm newborns have lower short-term mortality when respiratory support during resuscitation is started with 21% oxygen (air) versus 100% oxygen. This has been attributed to lower oxygen toxicity and free radical damage. However, the same principle is difficult to apply on a preterm neonate, especially on very low birth weight neonates. This is because preterm neonates may need supplemental oxygen because of lung immaturity, but antioxidant defenses are also suboptimal until the third trimester. Moreover hypoxia and hyperoxia both can trigger lung injury in very preterm babies, thus prolonging the respiratory support and duration of stay. Very preterm infants often need oxygen supplementation to prevent hypoxia. Extremely preterm infants (i.e., those born below 28 +6 weeks gestation), despite advances in perinatal care, continue to be vulnerable to the consequences of both hypoxia and oxidative stress. Therefore, whereas, resuscitation with 21% has the potential to increase mortality, at the same time 100% oxygen during initial few minutes of life also has the potential to increase the morbidity due to free radical injury. A clinical equipoise hence exists for optimal oxygen use in resuscitation of preterm neonates. This study is hence planned to see the outcome of two oxygen concentrations in intermediate zone (30% and 60%) for delivery room resuscitation in preterm neonates less than 32 weeks of gestation.