A preterm infant of 28 weeks gestation is delivered. Initial steps of NRP are performed. The baby has labored breathing and HR is 100 bpm. The correct initial FiO2 for positive pressure ventilation in this preterm (<35 weeks) infant per NRP 2023 guidelines is:

• A 100% oxygen — all compromised infants require full oxygen
• B 21% (room air) — start with room air for all preterm infants
• C 40% oxygen — intermediate starting point
• D 21–30% oxygen — start low, titrate using oximetry to target SpO2 tables ✓

Explanation

Per 2020 NRP and current evidence, PPV for infants <35 weeks should begin with 21–30% FiO2 (not 100% as was historical practice), titrating upward based on pulse oximetry and NRP target SpO2 tables. Hyperoxia in preterm infants is associated with retinopathy of prematurity, chronic lung disease, and oxidative injury. Room air alone (21%) may be insufficient for some; hence the recommended starting range is 21–30% for preterm infants.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.