The article examines the objective, findings, and clinical context described in EBNEO Commentary on Oxygen Concentration for Preterm Infant Resuscitation: Insights from the TORPIDO 30/60 Trial.
Approach:
Trial design: Multicenter randomized controlled trial of infants born at 23–28 weeks’ gestation, assigned to resuscitation starting at FiO₂ 0.3 or 0.6.
Commentary: The commentary assesses trial strengths, methodological limitations, clinical outcomes, and relevance to current recommendations.
Key Findings:
Initial FiO₂ assignment was not associated with death or brain injury at 36 weeks’ corrected gestational age.
Oxygen saturation varied substantially, and by 5 minutes the groups’ average FiO₂ concentrations were similar.
Post hoc exploratory analyses found a higher incidence of ventriculomegaly in the FiO₂ 0.6 group.
Interpretation:
The authors describe the trial as an important contribution to evidence informing preterm resuscitation guidelines, while noting that the brief exposure to different initial FiO₂ levels and subsequent similar oxygen concentrations may have limited separation between groups.
Limitations:
Staff were unmasked, and the proportion of eligible infants randomized was unclear.
Only FiO₂ 0.3 and 0.6 were compared; whether a wider difference would produce clinically important effects is unknown.
The study did not evaluate effects of concurrent delivery-room interventions or report bronchopulmonary dysplasia, retinopathy of prematurity, or major disability at 2–3 years.
Local practices and clinician preferences may have influenced care across participating centers.
Conclusion:
The commentary reports current ILCOR recommendations for initial FiO₂: greater than 0.3 for infants younger than 32 weeks, 0.3 for those 32–34 weeks, and 0.21 for infants older than 35 weeks.
Higher medical expenses increased financial anxiety and reduced willingness to schedule recommended procedures in 3 studies, with stronger effects among financially stressed participants.
