AIROPLANE: 30% oxygen did not reduce support at room exit, but escalation was lower

In AIROPLANE, ongoing support at delivery-room exit was 700/964 (72.6%) with initial FiO2 0.30 and 626/854 (73.3%) with 0.21, a risk difference of -0.83 points (95% CI -4.33 to 2.67). Two secondary escalation outcomes favored 0.30, but open-label cluster allocation, no multiplicity adjustment, and no post-discharge outcomes keep this from being a protocol verdict.

THE HOT TAKE

The primary outcome barely moved. Two escalation measures did. That is enough to investigate, not enough to turn 30% oxygen into a universal starting rule.

AIROPLANE was an unblinded cluster randomized crossover trial in 26 Australian maternity hospitals. It included 1,818 infants born from 32+0 to 35+6 weeks who had no known major congenital anomaly and began respiratory support within 3 minutes of birth. Hospitals started one period with FiO2 0.30 and the other with FiO2 0.21. The analysis included 964 infants in the 0.30 condition and 854 in the 0.21 condition.

The primary outcome occurred in 700/964 infants (72.6%) with initial FiO2 0.30 and 626/854 (73.3%) with 0.21. The cluster- and period-aware risk difference was -0.83 percentage points (95% CI -4.33 to 2.67). The interval rules out the 8-point reduction used in the original power calculation, but it remains compatible with a modest benefit or modest harm. This was not an equivalence result.

WHAT THE SECONDARY SIGNALS SHOWED