Bold takeaway: Starting extremely preterm babies on a higher oxygen level during resuscitation does not improve survival or reduce brain injury compared with a lower oxygen approach. The TORPIDO 30/60 trial provides fresh clarity on a long-standing debate in neonatology.
A large international study asked whether beginning resuscitation with an inspired oxygen fraction (FiO₂) of 0.6 offers any advantage over 0.3 for infants born between 23 and 28 weeks of gestation. For decades, clinicians have weighed the risks of too little oxygen, which can cause hypoxia, against the dangers of too much oxygen, which may lead to oxidative damage and potential neurodevelopmental harm. The question has remained unresolved until now.
Design and scope
The TORPIDO 30/60 randomized trial enrolled 1,641 newborns across 31 hospitals in six countries, with 1,469 infants included in the primary analysis. Participants were randomized just before birth, and those with congenital conditions likely to affect oxygenation or survival were excluded. Across sites in Australia, India, Malaysia, Singapore, Spain, and the United States, clinicians used a standardized protocol: at birth, infants received either FiO₂ 0.3 or 0.6, and oxygen levels were subsequently titrated to established pulse oximetry targets during the first 10 minutes of life.
Key findings
- At 36 weeks’ corrected gestational age, the combined outcome of death or brain injury was nearly identical between groups: 46.9% for the FiO₂ 0.6 group versus 47.8% for the FiO₂ 0.3 group (relative risk 0.98; 95% CI 0.89–1.09).
- Escalation to 100% oxygen occurred in 41% of the FiO₂ 0.6 group and 38% of the FiO₂ 0.3 group, indicating that the initial oxygen strategy did not drive markedly different clinical trajectories.
Implications for practice and research
These results show that a higher initial oxygen concentration does not yield measurable improvements in early outcomes for extremely preterm infants. The researchers emphasize that this study establishes a robust evidence base to guide future work exploring more nuanced or individualized oxygen strategies that might enhance safety or long-term neurodevelopment.
Why this matters
Prematurity continues to be a leading cause of neonatal mortality worldwide. The TORPIDO 30/60 trial offers timely guidance for frontline clinicians and reinforces the need for precision in resuscitation practices at birth.
Reference
Oei JL et al. Targeted Oxygen for Initial Resuscitation of Preterm Infants: The TORPIDO 30/60 Randomized Clinical Trial. JAMA. 2025; doi: 10.1001/jama.2025.23327
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