A MAJOR international trial has found that starting extremely preterm infants on a higher concentration of oxygen during resuscitation does not reduce the risk of death or brain injury compared with a lower-oxygen approach, offering long-needed clarity for a long-debated question in neonatal care.
The TORPIDO 30/60 randomised clinical trial examined whether initiating resuscitation with a fraction of inspired oxygen (FiO₂) of 0.6 provides any clinical advantage over 0.3 for infants born between 23- and 28-weeks’ gestation. The optimal oxygen level for initial resuscitation in this vulnerable group has remained uncertain for decades, with concerns on both sides: too little oxygen may risk hypoxia, while too much may contribute to oxidative injury and long-term neurodevelopmental harm.
The study involved 1641 newborns across 31 hospitals in six countries, with 1469 infants included in the primary analysis. Infants were randomised shortly before birth, with exclusions applied to those with congenital conditions likely to affect oxygenation or survival. Across sites in Australia, India, Malaysia, Singapore, Spain, and the United States, clinicians used a standardised approach: infants received either 0.3 or 0.6 FiO₂ initially, after which oxygen levels were titrated according to established pulse oximetry targets during the first 10 minutes of life.
Preterm Resuscitation: Higher Oxygen Offers No Added Benefit
At 36 weeks’ corrected gestational age, the combined rate of death or brain injury was virtually identical between groups: 46.9% in infants who began resuscitation at FiO₂ 0.6 and 47.8% in those started at 0.3 (relative risk 0.98; 95% CI 0.89–1.09). Rates of escalation to 100% oxygen were also similar (41% vs 38%), suggesting that initial oxygen choice did not alter subsequent clinical management.
How the Study Informs Future Neonatal Research
The findings indicate that a higher initial oxygen concentration does not confer measurable benefit in early outcomes for extremely preterm infants. According to the researchers, these results form an essential evidence base for future studies exploring whether more nuanced or individualised oxygen strategies might yield improvements in safety or long-term neurodevelopment.
With prematurity remaining a leading cause of neonatal mortality worldwide, TORPIDO 30/60 provides timely guidance for frontline clinicians, and underscores the ongoing need for precision-driven approaches to resuscitation in the delivery room.
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
