Hypoxemic Resuscitation in Newborn Piglets: Recovery of Somatosensory Evoked Potentials, Hypoxanthine, and Acid-Base Balance

Feet, Björn Aage; Medbø, Sverre; Rootwelt, Terje; Ganes, T.; Saugstad, Ola Didrik

doi:10.1203/00006450-199805000-00019

Cited by 11 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Piglet studies we performed in the 1990s [88] demonstrated that it is possible to resuscitate with 18% and perhaps even 15% oxygen. However, 12% oxygen seems to be insufficient to restore metabolic and neurological functions.…”

Section: Oxygenation Of Term and Preterm Newborn Infantsmentioning

confidence: 99%

Oxygenation of the Newborn: A Molecular Approach

Saugstad

Sejersted²,

Solberg³

et al. 2012

Neonatology

View full text Add to dashboard Cite

In this review oxygenation and hyperoxic injury of newborn infants are described through molecular and genetic levels. Protection and repair mechanisms that may be important for a new understanding of oxidative stress in the newborn are discussed. The research summarized in this article represents a basis for the reduced oxygen supplementation and oxidative load of newborn babies, especially since the turn of the century. The mechanisms discussed may also contribute to an understanding of why hyperoxic resuscitation of the newborn may damage DNA and affect its repair, thus increasing the risk that it may be carcinogenic. Today, term babies should be resuscitated with air rather than 100% oxygen and very and extremely low birth weight infants in need of stabilization or resuscitation at birth should be administered initially 21–30% oxygen and the level should be titrated according to the response, preferably measured by pulse oximetry. In the postnatal period the oxygen saturation should be targeted low <95%; however, saturations between 85 and 89% seem to increase mortality. The optimal oxygen saturation target for these infants postnatally is still unknown.

show abstract

Section: Oxygenation Of Term and Preterm Newborn Infantsmentioning

confidence: 99%

Oxygenation of the Newborn: A Molecular Approach

Saugstad

Sejersted²,

Solberg³

et al. 2012

Neonatology

View full text Add to dashboard Cite

show abstract

“…In this and a series of subsequent experiments, we confirmed that 21% oxygen is as efficient as 100% oxygen for resuscitation. [10][11][12][13][14][15][16] The findings in the newborn piglet were consistent, and I realized that the time had come to test our hypothesis in a clinical study. Siddarth Ramji in New Delhi immediately agreed to participate, and the pilot clinical trial was carried out in India, enrolling 84 newborn infants randomized to room air or 100% oxygen resuscitation.…”

Section: Discovery Through a Failurementioning

confidence: 56%

Why are we still using oxygen to resuscitate term infants?

Saugstad

2010

J Perinatol

View full text Add to dashboard Cite

This article summarizes the historical background for the use of oxygen during newborn resuscitation and describes some of the research and the process of changing the previous practice from a high-to a low-oxygen approach. Findings of a recent Cochrane review suggest that more than 100 000 newborn lives might be saved globally each year by changing from 100 to 21% oxygen for newborn resuscitation. This estimate represents one of the largest yields for a simple therapeutic approach to decrease neonatal mortality in the history of pediatric research. Available data also suggest that, for the very low birth weight infant, use of the low-oxygen approach should be considered with the understanding that some of the smallest and sickest preterm neonates will need some level of oxygen supplementation during the first minutes of postnatal life. As more data are needed for the very preterm population, creation of strict guidelines for these infants would be premature at present. However, it can be stated that term and late preterm infants in need of resuscitation should, in general, be started on 21% oxygen, and if resuscitation is not started with 21% oxygen, a blender should be available, enabling the administration of the lowest FiO 2 possible to keep heart rate and SaO 2 within the target range. For extremely low birth weight infants, initial FiO 2 could be between 0.21 and 0.30 and adjusted according to the response in SaO 2 and heart rate.

show abstract

“…We did not find any significant changes on the platelet activation and aggregatory function in the 21% and 18% reoxygenation groups. Studies using even lower oxygen concentration seem interesting in order to achieve significantly less oxidative stress during resuscitation, but this may not be feasible in resuscitation as evidenced by the suboptimal hemodynamic recovery in asphyxiated piglets (21).…”

Section: Discussionmentioning

confidence: 99%

“…Although there are controversies over the use of 21% or 100% oxygen in neonatal resuscitation, it is apparent that 21% reoxygenation causes less oxidative stress than 100% reoxygenation (20). The use of hypoxic gas mixture of 17% to 19% oxygen has been studied in the resuscitation of newborn piglets (21) and recently used as a strategy to support the cardiopulmonary hemodynamics in children with congenital heart disease (14). Here we demonstrated a transient ex vivo aggregatory dysfunction of platelets in hypoxic newborn piglets resuscitated with 100% oxygen.…”

Section: Discussionmentioning

confidence: 99%

Temporal Platelet Aggregatory Function in Hypoxic Newborn Piglets Reoxygenated With 18%, 21%, and 100% Oxygen

Postma

Emara²,

Obaid³

et al. 2007

Shock

View full text Add to dashboard Cite

Thromboembolic and bleeding complications are common after asphyxia. We studied the temporal effects of different oxygen concentrations used in resuscitating hypoxic newborn piglets on platelet aggregatory function. Alveolar normocapnic hypoxia (fractional inspired oxygen concentration = 0.15) was induced in piglets (1-4 d, 1.7-2.5 kg) for 2 h, followed by reoxygenation with 18%, 21%, or 100% oxygen for 1 h and then 21% for 2 h (n = 8-9 per group). Control piglets underwent surgery with no hypoxia-reoxygenation (n = 5). Platelet counts and collagen-stimulated (2-10 microg/mL) whole blood aggregation were studied at normoxic baseline and at 3 h, 2 d, and 4 d of recovery. Platelet activation markers including plasma thromboxane B2 and matrix metalloproteinase 2 and 9 levels were measured. At 2 h hypoxia (mean PaO2 30-35 mmHg), all piglets were hypotensive and acidotic (mean pH 7.19-7.24). In 100% reoxygenation piglets, the concentration-response curves of collagen-stimulated platelet aggregation were significantly shifted upward at 3 h and 2 d of recovery with no differences in the collagen concentration required to induce 50% of maximum aggregation, and this normalized to baseline on 4 d. In the 18% and 21% reoxygenated groups, there were no changes in platelet aggregation during the experiment. Platelet counts were not different between groups and over time. Hypoxic-reoxygenated piglets had increased plasma thromboxane B2 (100% group) and matrix metalloproteinase-2 levels (21% and 100% groups) (versus respective baseline, P < 0.05), with no difference between experimental groups. These findings suggest transient platelet activation in hypoxic newborn piglets resuscitated with 100% but not with 18% and 21% oxygen, of which the clinical significance requires further investigation.

show abstract

Hypoxemic Resuscitation in Newborn Piglets: Recovery of Somatosensory Evoked Potentials, Hypoxanthine, and Acid-Base Balance

Cited by 11 publications

References 39 publications

Oxygenation of the Newborn: A Molecular Approach

Oxygenation of the Newborn: A Molecular Approach

Why are we still using oxygen to resuscitate term infants?

Temporal Platelet Aggregatory Function in Hypoxic Newborn Piglets Reoxygenated With 18%, 21%, and 100% Oxygen

Contact Info

Product

Resources

About