Background:Oxygen exposure during delivery room (DR) resuscitation, even when brief, is potentially toxic. A practice plan (PP) was introduced for very low birth weight (VLBW) infants ⩽1500 g as follows: initial FiO2 from 0.21 to 1.0 using blenders, oxygen guided by oximetry to maintain saturation between 85% to 95% from birth.Objective:To determine whether the initiating FiO2 could be safely lowered, and by doing so whether the number of infants with a PaO2 >80 mm Hg could be minimized on admission, as well as lowering oxygen requirement at 24 h.Methods:In all, 53 infants admitted between June 2006 and June 2007 were evaluated and compared with 47 infants from 2004 managed with 100 % oxygen (historical comparison group (HC)).Result:Stabilization/Resuscitation included intubation (n=28) and continuous positive airway pressure (CPAP) (n=25); no cardiopulmonary resuscitation (CPR). The heart rate increased rapidly in all cases. The initiating FiO2 decreased from 0.42 to 0.28 over 12 months (P=0.00005); 14 (26%) were resuscitated with room air. Correspondingly, the pH increased from 7.24 to 7.30 (P=0.002) and PCO2 decreased from 53 to 41 (P=0.001). A comparison of infants during the PP with the HC revealed that 36/53 versus 21/47 had an initial PaO2 <80 mm Hg (P=0.02); the median PaO2, that is, 64 versus 86 and saturation, that is, 95% versus 99% on admission were significantly lower. The median FiO2 at 24 h was 0.25 versus 0.40.Conclusion:DR resuscitation of VLBW infants can be initiated with less oxygen even with room air without concomitant overt morbidity. This change was associated with more infants with an initial PaO2 <80 mm Hg and lower saturation values on admission as well as a lower FiO2 requirement at 24 h.
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