Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: a meta-analysis

Oei, Ju Lee; Vento, Máximo; Rabi, Yacov; Wright, Ian; Finer, Neil N.; Rich, Wade; Kapadia, Vishal; Aune, Dagfinn; Rook, Denise; Tarnow‐Mordi, William; Saugstad, Ola Didrik

doi:10.1136/archdischild-2016-310435

Cited by 86 publications

(55 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Protocols to achieve normal transitional saturations measured by pulse oximetry at the right wrist usually result in extremely low-birth-weight infants requiring around 30-40% oxygen by about 10 min of age [38,39]. Starting low and working up is better than starting high and working down in terms of reducing oxidative stress, although starting with 21% may be too low for the most immature babies who may need at least 30% oxygen, and further studies are under way to resolve this issue [40]. Measuring heart rate by auscultation or cord palpation may not be accurate, and although ECG in the delivery room offers a more rapid practical alternative to pulse oximetry for measuring heart rate, it is not widely available and may not offer any meaningful advantage in terms of improving outcome.…”

Section: Delivery Room Stabilizationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

View full text Add to dashboard Cite

Advances in the management of respiratory distress syndrome (RDS) ensure that clinicians must continue to revise current practice. We report the third update of the European Guidelines for the Management of RDS by a European panel of expert neonatologists including input from an expert perinatal obstetrician based on available literature up to the beginning of 2016. Optimizing the outcome for babies with RDS includes consideration of when to use antenatal steroids, and good obstetric practice includes methods of predicting the risk of preterm delivery and also consideration of whether transfer to a perinatal centre is necessary and safe. Methods for optimal delivery room management have become more evidence based, and protocols for lung protection, including initiation of continuous positive airway pressure and titration of oxygen, should be implemented from soon after birth. Surfactant replacement therapy is a crucial part of the management of RDS, and newer protocols for surfactant administration are aimed at avoiding exposure to mechanical ventilation, and there is more evidence of differences among various surfactants in clinical use. Newer methods of maintaining babies on non-invasive respiratory support have been developed and offer potential for greater comfort and less chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease although minimizing the time spent on mechanical ventilation using caffeine and if necessary postnatal steroids are also important considerations. Protocols for optimizing the general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

show abstract

Section: Delivery Room Stabilizationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

et al. 2016

View full text Add to dashboard Cite

show abstract

“…Currently, there is no clear evidence that the use of respiratory function monitoring, or targeting different tidal volumes or oxygen supplementation at birth affects BPD [33]. Another strategy that showed promise in reducing lung injury in animal models and early clinical studies is sustained inflation at birth to improve functional residual capacity.…”

Section: Strategies For Prevention Of Bpd: “Hit – or – Miss”mentioning

confidence: 99%

Bronchopulmonary Dysplasia: 50 Years after the Original Description

2019

View full text Add to dashboard Cite

Bronchopulmonary dysplasia (BPD) is one of the few diseases in neonatal medicine that has continued to evolve since its first description about 50 years ago. Over these years, advancements in neonatal medicine such as antenatal steroids and exogenous surfactant therapy have significantly reduced neonatal mortality and lowered the limits of viability for preterm infants. Although the incidence of BPD continues to be high, especially in extremely low birth weight infants, the clinical picture has evolved into a milder disease with low mortality or significant morbidities. This new BPD is the result of complex interactions between altered alveolar and vascular development, injury by ante- and postnatal pathogenic factors, and reparative processes in the lung. There has been significant progress in our understanding of risk factors for BPD, but challenges persist in its definition, and in finding effective preventive strategies. There are promising developments with newer preventive interventions such as mesenchymal stem cells, exosomes, immunomodulators, and growth factors, but they are still in preclinical stage. The future challenges include finding ways to define BPD based on the severity of lung pathology, which can better predict long-term outcomes, development of early predictors of lung disease, and finding innovative and evidence-based preventive and management strategies.

show abstract

“…More recently, a meta-analysis of eight randomized studies of low (≤30% O 2 ) vs. high oxygen (≥65% O 2 ) resuscitation, found no difference in major clinical outcomes including death or BPD in infants ≤28 weeks gestation. 30 The results of all these studies come with limitations. Meta-analysis included studies done over a relatively long period of time, during which time the clinical practices have evolved regarding management of BPD.…”

Section: Oxygen Resuscitation and Clinical Outcomes In Premature Neonmentioning

confidence: 99%

Oxygen and Resuscitation: Saturations, Oxidative Stress and Outcomes in Premature Infants

Kumar¹

2016

Pediatr Neonatal Nurs Open J

View full text Add to dashboard Cite

Fetus develops in a relatively hypoxemic environment in utero, however they need supplemental oxygen at birth when born prematurely ≤32 weeks' gestation. Reduced antioxidant defenses from lack of induction of antioxidant enzymes at birth, predispose premature infant susceptible to toxic effects of oxygen such as bronchopulmonary dysplasia and brain injury. Studies have demonstrated that even short exposures to 100% oxygen at birth could have long term implications. Guidelines and nomograms were published in 2010 regarding oxygen concentrations to be administered along with the oxygen saturations (SpO 2 ) to be targeted in the first ten minutes after birth in both term and premature infants. We review the impact of differing oxygen concentrations in the first 10 minutes soon after birth on oxygen saturations, the biochemical effects of oxidative stress and on clinical outcomes in premature infants. Initiating resuscitation with an oxygen concentration of 21% O 2 to 30% O 2 as recommended by resuscitation guidelines is a good starting point, despite the lack of evidence of well-defined SpO 2 targets in premature neonates, which necessitate large clinical trials. Starting low oxygen concentration at resuscitation, facilitates lower oxidative stress which is desirable in premature infants with immature anti-oxidant defenses at birth. However, there is insufficient evidence to indicate that resuscitation with lower oxygen concentration (≤30% O 2 ) at birth will decrease BPD or other clinical outcomes in premature neonates.

show abstract

Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: a meta-analysis

Cited by 86 publications

References 32 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update

Bronchopulmonary Dysplasia: 50 Years after the Original Description

Oxygen and Resuscitation: Saturations, Oxidative Stress and Outcomes in Premature Infants

Contact Info

Product

Resources

About