Landmark AIROPLANE trial provides new evidence to inform care of premature babies

A large Australian study involving more than 1,800 premature babies has provided new evidence to guide the use of oxygen during the first minutes after birth.

The AIROPLANE trial, led by researchers at the Royal Women's Hospital, is one of the largest of its kind. It included 26 hospitals in Victoria and New South Wales. It compared two common oxygen levels for babies born between 32 to 35 weeks' gestation who needed breathing support right after birth.

The findings are now published in JAMA. They will help shape future guidelines for newborn care, both nationally and internationally.

Babies born between 32 and 35 weeks make up most preterm births. Yet, there hasn’t been much research to guide doctors on how much oxygen to use when starting breathing support.

Current international guidelines don’t suggest a specific starting oxygen level for babies in this age group. This is because there isn’t enough evidence available.

The AIROPLANE trial was designed to help address that gap.

The study looked at babies who began breathing support with 21 per cent oxygen, the amount found in room air, versus those who started with 30 per cent oxygen.

Researchers found no difference between the two groups in the study's primary outcome. This outcome checked if babies still needed breathing support when leaving the delivery room. However, the study also showed that babies who started on 30 per cent oxygen needed less support right after birth and over the next few days.

Associate Professor Louise Owen is a neonatologist at the Women’s and a member of the Clinical Sciences Group at Murdoch Children’s Research Institute. She is also Principal Researcher at the University of Melbourne and said the findings provide evidence where little previously existed.

"Most premature babies are born between 32 and 35 weeks. But this group is often not included in newborn research," A/Prof. Owen said.

"Hospital guidelines use a variety of methods since there isn’t enough evidence to back one starting oxygen level over another.

"This study provides information to consider when reviewing and updating guidelines."

The trial involved specialist, regional, metropolitan, public, and private hospitals. This let researchers study babies getting care in many different settings.

A/Prof. Owen said this was an important part of the project.

"Research is often concentrated in large specialist hospitals. But these babies born early receive their care in many different settings," she said.

"We wanted the study to reflect where these babies are actually born and cared for."

The researchers developed the study with input from families and people with lived experience of preterm birth, who helped shape the research design. The study used a new QR-code system to collect data. This let local clinicians quickly record information during routine care. It also helped hospitals with various research experience levels to participate.

"By bringing together hospitals from Victoria and New South Wales, we answered a key clinical question that no single hospital could solve alone," A/Prof. Owen said.

"It shows how collaboration can help generate evidence for groups of babies who have not always been included in large clinical trials."

The AIROPLANE trial was led by the Royal Women's Hospital. It worked with the Murdoch Children's Research Institute, the University of Melbourne, and hospitals in Victoria and New South Wales.

Read the full AIROPLANE study in JAMA: https://jamanetwork.com/journals/jama/fullarticle/2853874