Room-air Versus Oxygen Administration for Resuscitation of Preterm Infants: the ROAR Study

Objective: We conducted a blinded, prospective, randomized control trial to determine which oxygen-titration strategy was most effective at achieving and maintaining oxygen saturations of 85% to 92% during delivery-room resuscitation.

Methods: Infants born at 32 weeks' gestation or less were resuscitated either with a static concentration of 100% oxygen (high-oxygen group) or using an oxygen-titration strategy starting from a concentration of 100% (moderate-oxygen group), or 21% oxygen (low-oxygen group). In the moderate- and low-oxygen groups, the oxygen concentration was adjusted by 20% every 15 seconds to reach a target oxygen saturation range of 85% to 92%. Treatment failure was defined as a heart rate slower than 100 beats per minute for longer than 30 seconds.

Results: The moderate-oxygen group spent a greater proportion of time in the target oxygen saturation range (mean: 0.21 [95% confidence interval: 0.16-0.26]) than the high-oxygen group (mean: 0.11 [95% confidence interval: 0.09-0.14]). Infants in the low-oxygen group were 8 times more likely to meet the criteria for treatment failure than those in the high-oxygen group (24% vs 3%; P = .022). The 3 groups did not differ significantly in the time to reach the target oxygen saturation range.

Conclusions: Titrating from an initial oxygen concentration of 100% was more effective than giving a static concentration of 100% oxygen in maintaining preterm infants in a target oxygen saturation range. Initiating resuscitation with 21% oxygen resulted in a high treatment-failure rate.