High PaO(2) occurs very rarely in neonates breathing supplemental oxygen when their pulse oxygen saturation values are 85% to 93%. This pulse oxygen saturation range also is infrequently associated with low PaO(2) values. Pulse oxygen saturation values of >93% are frequently associated with PaO(2) values of >80 mmHg, which may be of risk for some newborns receiving supplemental oxygen.
AimTo identify whether pulse oximetry technology is associated with decreased retinopathy of prematurity (ROP) and laser treatment.MethodsInborn infants <1250 g who had eye exams were compared at two centres in three periods. In Period 1, SpO2 target was ≥93% and pulse oximetry technology was the same in both Centres. In Period 2, guidelines for SpO2 88–93% were implemented at both centres and Centre B changed to oximeters with signal extraction technology (SET®) while Centre A did not, but did so in Period 3. One ophthalmology department performed eye exams using international criteria.ResultsIn 571 newborns <1250 g, birth weight and gestational age were similar in the different periods and centres. At Centre A, severe ROP and need for laser remained the same in Periods 1 and 2, decreasing in Period 3–6% and 3%, respectively. At Centre B, severe ROP decreased from 12% (Period 1) to 5% (Period 2) and need for laser decreased from 5% to 3%, remaining low in Period 3.ConclusionIn a large group of inborn infants <1250 g, a change in clinical practice in combination with pulse oximetry with Masimo SET, but not without it, led to significant reduction in severe ROP and need for laser therapy. Pulse oximetry selection is important in managing critically ill infants.
AimTo assess the time to obtain reliable oxygen saturation readings by different pulse oximeters during neonatal resuscitation in the delivery room or NICU.MethodsProspective study comparing three different pulse oximeters: Masimo Radical-7 compared simultaneously with Ohmeda Biox 3700 or with Nellcor N395, in newborn infants who required resuscitation. Members of the research team placed the sensors for each of the pulse oximeters being compared simultaneously, one sensor on each foot of the same baby. Care provided routinely, without interference by the research team. The time elapsed until a reliable SpO2 was obtained was recorded using a digital chronometer. Statistical comparisons included chi-square and student's T-test.ResultsThirty-two infants were enrolled; median gestational age 32 weeks. Seventeen paired measurements were made with the Radical-7 and Biox 3700; mean time to a stable reading was 20.2 ± 7 sec for the Radical-7 and 74.2 ± 12 sec for the Biox 3700 (p = 0.02). The Radical-7 and the N- 395 were paired on 15 infants; the times to obtain a stable reading were 20.9 ± 4 sec and 67.3 ± 12 sec, respectively (p = 0.03).ConclusionThe time to a reliable reading obtained simultaneously in neonatal critical situations differs by the type of the pulse oximeter used, being significantly faster with Masimo Signal Extraction Technology. This may permit for better adjustments of inspired oxygen, aiding in the prevention of damage caused by unnecessary exposure to high or low oxygen.
BackgroundDelayed mortality may be associated with prolonged suffering and also with emotional, economic, and resource costs. The age at the time of death in extremely low birth weight infants (ELBW) is widely variable. The influence on this variability of delivery room cardiopulmonary resuscitation (DR-CPR) has not been investigated.ObjectiveTo analyze if the age at the time of death in infants < 1,200 g is different in those who received DR-CPR compared to those who died but did not require DR-CPR.Design/MethodsAnalysis of all infants < 1,200 g who died and had been born at two Emory perinatal centers in the last 5 years (1/2000-12/2004). Exclusion criteria were major congenital malformations and provision of only comfort care. DR-CPR was defined as chest compression and/or epinephrine use in the delivery room (DR). Demographics included Apgar score, gestational age, gender, prenatal steroids, multiple pregnancies, mode of delivery, age at time of death and others. Comparisons by chi square, Fisher's, Student t, and RR when appropriate (whole group and BW specific).ResultsA total of 87 infants < 1,200 g who died met enrollment criteria; 26 of them (30%) received DR-CPR. Of the 87 infants, 25% died in first day (d); 18% at 1-3 d; 5% between 4 and 7 d; 29% between 8 and 28 d, and 23% > 28 d of age. The DR-CPR group was similar to the no DR-CPR group in birth weight (726 6 160 vs 731 6 176) and gestational age (24.8 6 1.9 vs 25.3 6 2.2). The average length of stay (ALOS) was widely variable (21.8 6 47 vs 30.7 6 56.9; p = .669). Death in the DR (27% vs 0%; p = .000), in the first 12 hours of life (38% vs 7%; p = .001) and in the first day (42% vs 20%; p = .047) was more frequent in the DR-CPR group. Death after 28 d was 11.5% in DR-CPR vs 26.6% in no DR-CPR infants (p = .2); and the median length of stay for these infants was 156.00 d vs 41.00 d, respectively.ConclusionA large proportion of the infants < 1,200 g who die do so after many days in the hospital. Exposure to DR-CPR is associated with a higher proportion of early mortality. However, infants exposed to DR-CPR who survive > 28 days die after a prolonged length of stay. It remains to be determined if criteria can be identified to avoid delaying the inevitable.
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