Low Oxygen Tension in the Management of Newborn Infants

Sjöstedt, Sven; Rooth, Gösta

doi:10.1136/adc.32.165.397

Cited by 33 publications

(9 citation statements)

References 21 publications

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“…It is of interest that in the 1950s preterm infants were treated in a hypoxemic environment with apparently good results [94]. Recently, a randomized study confirmed that a low oxygen saturation (85–89%) compared with a high (91–95%) reduces ROP [95].…”

Section: Oxygenation Of Term and Preterm Newborn Infantsmentioning

confidence: 99%

Oxygenation of the Newborn: A Molecular Approach

Saugstad

Sejersted²,

Solberg³

et al. 2012

Neonatology

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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.

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Section: Oxygenation Of Term and Preterm Newborn Infantsmentioning

confidence: 99%

Oxygenation of the Newborn: A Molecular Approach

Saugstad

Sejersted²,

Solberg³

et al. 2012

Neonatology

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“…Human infants decrease V ˙ O 2 and body temperature during hypoxia [4,5] . This behavior is shared by infants of various other mammalian species including the rabbit [1] .…”

Section: Methodologiesmentioning

confidence: 99%

“…This is in agreement with previous investigations. Metabolic down-regulation is well documented during hypoxia in young or small mammals [1] including human infants [4,5] . This appears to be a regulated response [1,3,20] resulting from CNS mechanisms that lower the thermoregulatory set-point [1,21] .…”

Section: Whole-body V ˙ O 2 and Body Temperature During Acute Hypoxiamentioning

confidence: 99%

“…Animal stud-ies indicate that hypoxic hypometabolism is not due to a limitation in O 2 supply, but is a regulated decrease in O 2 demand specifi cally due to an inhibition of thermogenesis [1][2][3] . As a consequence hypoxemia in young and small mammals, including human infants, is often accompanied by a reduction in body temperature [1,[4][5][6] . In addition to reducing body energy needs during O 2 lack, such a spontaneous reduction in body temperature may also be benefi cial in terms of preventing or minimizing hypoxic/ischemic brain injury [7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

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Effect of Body Warming on Regional Blood Flow Distribution in Conscious Hypoxic One-Month-Old Rabbits

Seifert

Anna²,

Rohlicek

2006

Neonatology

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Background: Previous experiments have shown that warming hypoxic infants reduces total peripheral vascular resistance. This suggests that the usual vasoconstriction of less essential vascular beds during hypoxia may be reduced and that the normal redistribution of blood flow to more vital organs may be compromised. Objective:Evaluate the effect of body warming during hypoxia on the distribution of blood flow. Methods: The fluorescent microsphere technique was used to compare regional blood flow in 1-month-old rabbits during systemic hypoxia (10% inspired O₂) with (n = 9) and without (n = 10) body warming. Blood flow was measured in brain, stomach, small intestine, hindlimb muscle, skin, and kidneys. Arterial blood pressure, whole-body O₂ consumption, arterial blood O₂ saturation and blood gases were also measured. Measurements and Main Results: In hypoxia all animals decreased body temperature (–2°C). With hypoxia blood flow increased to brain and hindlimb muscle; decreased to stomach, small intestine, and kidneys, and was unchanged in skin. The increase in brain-blood flow maintained O₂ delivery at normoxic levels. Rewarming to the normoxic body temperature significantly changed blood flow in hypoxia. Brain blood flow increased by 102 ± 30% (mean ± SEM) thereby increasing O₂ delivery by 50 ± 23% above normoxic values. Blood flow also increased to skin, stomach, and small intestine. However, O₂ delivery to these tissues remained below normoxic levels. Conclusions: Warming during hypoxia may impose an additional cardiovascular demand. The changes in the pattern of blood flow distribution with mild warming during hypoxia support the hypothesis that warming represents a significant heat stress.

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“…4,[13][14][15] There is now considerable interest in exploring lower levels, and the belated concerns recall explorations conducted in Sweden a half-century ago. 16 It is encouraging to see that neonatal medicine is beginning to wake up after years of dogmatic slumber. 17 If the plans for an international oxygen-targeting trial (Pulse Oximeter Saturation Trial for Prevention of ROP) are conducted in the near future, 18 there is reason to hope that uncritical acceptance of authoritative opinion about the most frequently prescribed "drug" in the care of small neonates will come to an end, at long last.…”

mentioning

confidence: 98%