Oxygen Supplementation in the Neonatal Period: Changing the Paradigm

Vento, Máximo

doi:10.1159/000360646

Cited by 66 publications

(44 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A recent randomized controlled trial demonstrated that, after postnatal stabilization, keeping preterm babies within a high saturation target range (91-95%) increases the risk of ROP as compared to keeping them in a lower saturation range (85-89%) [9]. However, the lower saturation target resulted in a significantly higher risk of mortality compared to the higher saturation range; hence, the present protocol of oxygen supplementation recommends keeping the oxygen saturation within stringent security margins (90-95%) [10,11]. Although the impact of different oxygen supplementation conditions on the development of severe ROP has not been fully clarified, a recent report described that the significant risk factors for Indian ROP included a longer duration of ventilation and higher inspiratory oxygen (FiO 2 ) [12].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Oxygen Supplementation Status as a Risk Factor Associated with the Development of Severe Retinopathy of Prematurity

Enomoto¹,

Miki²,

Matsumiya³

et al. 2015

Ophthalmologica

View full text Add to dashboard Cite

Purpose: The effects of oxygen supplementation status and other clinical risk factors on the development of severe retinopathy of prematurity (ROP) were evaluated. Methods: Clinical records of 143 newborn infants with a gestational age of 32 weeks or less were reviewed. Severe ROP was diagnosed when photocoagulation due to progression to stage 3 was identified or when ‘plus disease' developed. The factors were evaluated with univariate and multivariate logistic regression analyses between the groups with severe (n = 24) and non-severe (n = 119) ROP. Results: Gestational age, birth weight, duration of oxygen supplementation, duration of directional positive air pressure and maximum fraction of inspiratory oxygen (FiO₂) were significantly associated with severe ROP in the univariate analyses. In the multivariate analysis, a longer duration of oxygen supplementation and a higher maximum FiO₂ were revealed as significant risk factors associated with severe ROP. Conclusions: Duration of oxygen supplementation and maximum FiO₂ required were important factors associated with severe ROP.

show abstract

Section: Introductionmentioning

confidence: 99%

Evaluation of Oxygen Supplementation Status as a Risk Factor Associated with the Development of Severe Retinopathy of Prematurity

Enomoto¹,

Miki²,

Matsumiya³

et al. 2015

Ophthalmologica

View full text Add to dashboard Cite

show abstract

“…In order to avoid hyperoxia, current recommendations advise resuscitation of preterm infants with a mixture of air and oxygen, and to use fraction of inspired oxygen (FiO 2 ) between 0.21 and 0.30 (9). FiO 2 should subsequently be titrated according to SpO 2 (10,11). General use of pulse oximetry has been shown to extensively reduce O 2 -derived toxicity in preterm infants (12).…”

mentioning

confidence: 99%

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

et al. 2015

View full text Add to dashboard Cite

Articles Translational Investigation nature publishing groupBackground: Hyperoxia and hypoxia influence morbidity and mortality of preterm infants. Automated closed-loop control of the fraction of inspired oxygen (FiO 2 ) has been shown to facilitate oxygen supplementation in the neonatal intensive care unit (NICU), but has not yet been tested during preterm resuscitation. We hypothesized that fully automated FiO 2 control based on predefined oxygen saturation (SpO 2 ) targets was applicable in both preterm resuscitation and ventilation. Methods: Twenty-two preterm lambs were operatively delivered and intubated in a modified EXIT procedure. They were randomized to receive standardized resuscitation with either automated or manual FiO 2 control, targeting SpO 2 according to the Dawson curve in the first 10 min and SpO 2 90-95% hereafter. Automated FiO 2 control also was applied during surfactant replacement therapy and subsequent ventilation. results: Time within target range did not differ significantly between manual and automated FiO 2 control during resuscitation, however automated FiO 2 control significantly avoided hyperoxia. Automated FiO 2 control was feasible during surfactant replacement and kept SpO 2 within target range significantly better than manual control during subsequent ventilation. conclusion: In our model, fully automated FiO 2 control was feasible in rapidly changing physiologic conditions during postnatal resuscitation and prevented hyperoxia. We conclude that closed loop FiO 2 control is a promising tool for the delivery room.o xygen supplementation is one of the most common therapeutic interventions in resuscitation and neonatal intensive care of term and preterm infants (1). However, both hypoxia and hyperoxia must be avoided because of their detrimental effects on morbidity and mortality in these children. While hypoxia may lead to direct and indirect cellular damage, hyperoxia has been associated with oxygen toxicity, oxidative stress (2), and chronic diseases of preterm infants such as bronchopulmonary dysplasia (3) and retinopathy of prematurity (4).Increase in oxygenation after birth is a gradual process (5). Measurement of oxygen saturation (SpO 2 ) by pulse oximetry in the delivery room is feasible in newborn resuscitation (6) and in preterm infants within the first minutes of life (7). SpO 2 reference values of preterm infants increase within the first 10 min of life (5). This has led to SpO 2 target values incorporated in the current European Resuscitation Council guidelines on resuscitation of newborns (8). In order to avoid hyperoxia, current recommendations advise resuscitation of preterm infants with a mixture of air and oxygen, and to use fraction of inspired oxygen (FiO 2 ) between 0.21 and 0.30 (9). FiO 2 should subsequently be titrated according to SpO 2 (10,11). General use of pulse oximetry has been shown to extensively reduce O 2 -derived toxicity in preterm infants (12). However, keeping SpO 2 manually within changing saturation limits during a hectic period of resu...

show abstract

“…In a paper from 2014, Vento (36) showed, in 5000 newborns with very low birth weight and gestation <28 GW, that premature babies who have SaO 2 in the region of 91-95% up to 36 GW, have significantly lower mortality and fewer severe disabilities than newborns with low SaO 2 (85-89%). It is still not known whether SaO 2 should be constant during this post-natal period, or if it should be reduced or even increased during infections, stagnation in growth, ROP and BPD.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Oxygen Therapy on the Development of Retinopathy of Prematurity

Jojić¹,

Predojević-Samardžić²,

Mavija³

et al. 2015

Pedaiatr Today

View full text Add to dashboard Cite

Objective -The aim of this study is to show the effect of oxygen therapy in premature babies on the development of severe ROP. Materials and methods -This retrospective research covered a period of two years, and included 108 premature babies, with birth weight <1500 g and gestational age <33 weeks, at the Children's Ward of the University Hospital Clinical Centre, Banja Luka. The effects of the length of oxygen therapy and episodes of hypoxia and hyperoxia on the development of severe ROP were analysed. Results -ROP was present in 64 (59.2%) newborns, of which 21 (19.4%) had severe ROP. The incidence of severe ROP is statistically higher with lower birth weight, <1150 g (p<0.01), lower gestational age <30 weeks, longer oxygen therapy and when there were frequent episodes of hyperoxia and hypoxia. By multiple logistic regression analysis, a very strong connection was established between severe ROP and exposure to episodes of hyperoxia (OR 32.73; CI 4.14-255.37), episodes of hypoxia (OR 14.08; CI 3.81-51.94), and oxygen therapy longer than 10 days (OR 15.54;. For most risk factors tested, there was a strong connection between severe ROP and birth weight <1250 g, gestational age <30 weeks, respiratory distress syndrome and perinatal asphyxia. Conclusion -Long-term oxygen therapy, prematurity and low birth weight with hypoxia are important factors in the development of severe ROP. Constant education is necessary of staff regarding the potentially harmful effects of oxygen in order to prevent both hypoxia and hyperoxia.

show abstract

Oxygen Supplementation in the Neonatal Period: Changing the Paradigm

Cited by 66 publications

References 54 publications

Evaluation of Oxygen Supplementation Status as a Risk Factor Associated with the Development of Severe Retinopathy of Prematurity

Evaluation of Oxygen Supplementation Status as a Risk Factor Associated with the Development of Severe Retinopathy of Prematurity

Fully automated predictive intelligent control of oxygenation (PRICO) in resuscitation and ventilation of preterm lambs

The Effect of Oxygen Therapy on the Development of Retinopathy of Prematurity

Contact Info

Product

Resources

About