Oxygen vs Air at Birth for Moderate- to Late-Preterm Infants: The AIROPLANE Cluster Randomized Crossover Trial.
Stacey R Peart, Brett J Manley, Jeanie L Y Cheong et al.
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In 30 seconds
The AIROPLANE trial was an unblinded, cluster randomized crossover study at 26 Australian maternity hospitals comparing initial oxygen concentrations of 0.30 and 0.21 during the first 3 minutes of respiratory support for infants born at 32 to 35 weeks’ gestation. Among 1818 newborns, ongoing respiratory support on leaving the delivery room occurred in 72.6% with Fio2 0.30 and 73.3% with Fio2 0.21 (risk difference, -0.83 [95% CI, -4.33 to 2.67]). Thus, the primary outcome did not differ, although some measures of escalation of respiratory support favored the higher initial oxygen concentration.
Key findings
- Ongoing respiratory support at delivery-room exit occurred in 700 of 964 newborns (72.6%) with Fio2 0.30 and 626 of 854 (73.3%) with Fio2 0.21.
- The primary-outcome risk difference was -0.83 [95% CI, -4.33 to 2.67].
- Higher levels of delivery-room support were less likely with Fio2 0.30 (proportional odds ratio, 0.70 [95% CI, 0.52-0.95]).
- Endotracheal ventilation beyond the delivery room occurred in 61 of 959 newborns (6.4%) with Fio2 0.30 and 79 of 852 (9.3%) with Fio2 0.21 (risk ratio, 0.69 [95% CI, 0.47-0.91]).
Why it matters
The trial addresses uncertainty about starting oxygen concentration during resuscitation of moderate- to late-preterm newborns. Its primary result indicates that starting at 0.30 rather than 0.21 did not change the proportion needing respiratory support on leaving the delivery room. Differences in some escalation outcomes may inform interpretation of early support needs, but do not establish a benefit on the primary outcome.
What to keep in mind
The trial was unblinded, and the primary outcome was respiratory support at delivery-room exit; the abstract does not report longer-term outcomes.