Hemoglobin oxygen saturation targets in the neonatal intensive care unit: Is there a light at the end of the tunnel?

Vali, Payam; Underwood, Mark A.; Lakshminrusimha, Satyanarayana

doi:10.1139/cjpp-2018-0376

Cited by 11 publications

(12 citation statements)

References 83 publications

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“…The definition of the optimal oxygenation of a newborn is tightly related to how oxygenation is assessed. There is a discrepancy between the ideal and the practical way to monitor the optimal oxygenation [12,13].…”

Section: Oxygen Assessmentmentioning

confidence: 99%

“…Cardiac output is dependent on heart rate and stroke volume. Therefore, there are several potential factors which can be manipulated in the clinical setting to affect oxygen delivery [12,13]. In normal conditions oxygen delivery is https://doi.org/10.1016/j.siny.2020.101078 * Corresponding author.…”

Section: Oxygen Delivery Extraction and Consumptionmentioning

confidence: 99%

“…PaO 2 is the measurement of the partial pressure of oxygen in arterial blood, whereas the SaO 2 is the percentage of hemoglobin bound with oxygen. SaO 2 varies with the PaO 2 in a nonlinear relationship and is affected by temperature, pH, 2,3 diphosphoglycerate, hemoglobin, and PaCO 2 [12,13,16]. Because oxygen saturation measured by pulse oximetry (SpO 2 ) is a noninvasive method, this has the last 3-4 decades been the predominant method to assess oxygenation of the newborns.…”

Section: Seminars In Fetal Andmentioning

confidence: 99%

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Oxygen metabolism and oxygenation of the newborn

Andresen

Saugstad

2020

Seminars in Fetal and Neonatal Medicine

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The premature infant is to some extent protected from hypoxia, however defense against hyperoxia is poorly developed. The optimal assessment of oxygenation is to measure oxygen delivery and extraction. At the bedside PaO 2 and SpO 2 are approximations of oxygenation at the tissue level. After birth asphyxia it is crucial to know whether or not to give oxygen supplementation, when, how much, and for how long. Oxygen saturation targets in the delivery room have been studied, but the optimal targets might still be unknown because factors like gender and delayed cord clamping influence saturation levels. However, SpO 2 > 80% at 5 min of age is associated with favorable long term outcome in preterm babies.Immature infants most often need oxygen supplementation beyond the delivery room. Predefined saturation levels, and narrow alarm limits together with the total oxygen exposure may impact on development of oxygen related diseases like ROP and BPD. Hyperoxia is a strong trigger for genetic and epigenetic changes, contributing to the development of these conditions and perhaps lifelong changes.

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Section: Oxygen Assessmentmentioning

confidence: 99%

Section: Oxygen Delivery Extraction and Consumptionmentioning

confidence: 99%

Section: Seminars In Fetal Andmentioning

confidence: 99%

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Oxygen metabolism and oxygenation of the newborn

Andresen

Saugstad

2020

Seminars in Fetal and Neonatal Medicine

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“…The goals of oxygen therapy for newborn infants are to provide sufficient oxygen to the tissues to avoid anaerobic metabolism and promote optimal brain and somatic growth. Sufficient oxygen should also be given to prevent hypoxic pulmonary vasoconstriction while avoiding the adverse effects of oxygen [1,2]. This dichotomy of oxygen is well known, especially in neonatology.…”

Section: Introductionmentioning

confidence: 99%

Oxygen in the First Minutes of Life in Very Preterm Infants

2021

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Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO2) and how FiO2 should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO2) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) <32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO2 and (2) the target SpO2 within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO2 of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA <29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO2 0.3 and adjusting the FiO2 to reach SpO2 of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate <100 bpm for >2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO2 in the first 10 min of life and a heart rate >100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.

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“…Intermittent hypoxemia (IH), a decrease in oxygenated hemoglobin (SpO 2 ), has been shown to correlate with responses to therapeutic blood transfusions [ 18 , 19 ], and are associated with later diagnoses of chronic lung disease [ 20 , 21 ], childhood asthma medication use [ 22 ], and mortality [ 23 ]. Continuous pulse oximetry monitoring provides a noninvasive modality for assessing oxygenation in the neonate and is used extensively in most NICUs [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Response to first dose of inhaled albuterol in mechanically ventilated preterm infants

et al. 2021

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Background Bronchodilator responses among preterm infants are heterogeneous. Bedside measurements may identify responders. Study design Respiratory measurements (Resistance, Compliance, FiO 2 ) and pulse oximetry (SpO 2 ) patterns were downloaded from infants <30 weeks gestational age during the first 2 months of life. Mechanically ventilated infants who received albuterol were included ( n = 33). Measurements were compared before and after first albuterol. Secondary analyses assessed subsequent doses. Results Median gestation and birthweight were 25 3/7 weeks and 730 g, respectively. Mean Resistance decreased post-albuterol ( p = 0.007). Sixty-eight percent of infants were responders based on decreased Resistance. Compliance and FiO 2 did not significantly differ. Percent time in hypoxemia (SpO 2 < 85%) decreased post albuterol ( p < 0.02). In responders, Resistance changes diminished with subsequent administration (all p = 0.01). Conclusions Ventilator resistance decreased in two-thirds of preterm infants, consistent with studies that utilized formal pulmonary function testing. Albuterol had a variable effect on delivered FiO 2 ; however, hypoxemia may be useful in evaluating albuterol response.

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Hemoglobin oxygen saturation targets in the neonatal intensive care unit: Is there a light at the end of the tunnel?

Cited by 11 publications

References 83 publications

Oxygen metabolism and oxygenation of the newborn

Oxygen metabolism and oxygenation of the newborn

Oxygen in the First Minutes of Life in Very Preterm Infants

Response to first dose of inhaled albuterol in mechanically ventilated preterm infants

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