Achieving Targeted Pulse Oximetry Values in Preterm Infants in the Delivery Room

Gandhi, Bheru; Rich, Wade; Finer, Neil N.

doi:10.1016/j.jpeds.2013.01.010

Cited by 34 publications

(26 citation statements)

References 16 publications

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“…[9][10][11] Data was analyzed and included if the baby's HR was <100 BPM within the first 90 s of resuscitation and the baby received mask positive pressure (PPV) during the first 2 min of resuscitation, the team used a Pedi-Cap with the initial mask ventilation and the baby was resuscitated on a warming bed with the data acquisition system available.…”

Section: Inclusion Criteriamentioning

confidence: 99%

“…1,2,[4][5][6][7][8] At UCSD Medical Center all babies that are at risk for requiring extensive resuscitation at birth are evaluated in a designated resuscitation suite outfitted with high definition audio/video monitoring along with multi-channel analog data capture. [9][10][11] In an ongoing quality improvement review of the recorded resuscitations, we observed that large increases in HR were associated with PediCap gold color change (PGC). CO 2 detection may be the first signal that there is adequate lung inflation, pulmonary blood flow and gas exchange.…”

Section: Introductionmentioning

confidence: 99%

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Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation

et al. 2014

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Section: Inclusion Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation

et al. 2014

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“…Gandhi et al [49] used a transitional oxygen targeting system (TOTS) that plots real-time SpO 2 values in relation to the 10th and 50th percentiles and enabled a greater proportion of total resuscitation time (52%) within the target range compared to controls (37%). Preterm infants resuscitated in 30% oxygen are estimated to have received 465.6 mL/kg of pure oxygen compared to 864 mL/kg in those resuscitated with 90% oxygen [46].…”

Section: Pulse Oximetry In the Delivery Roommentioning

confidence: 99%

Principles of pulse oximetry and its clinical application in neonatal medicine

Tin

Lal

2015

Seminars in Fetal and Neonatal Medicine

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“…42 Studies comparing different starting concentrations of O 2 to achieve target goal saturations and, more importantly, effects on both short-and long-term clinical outcomes are warranted; however, based on published studies so far, it seems unlikely that 21% vs 30% O 2 would result in significant differences. 8,22,23,[42][43][44][45] To optimize balance between excessive O 2 and hypoxia, future studies comparing different target SpO 2 ranges should be considered. 27,46 We speculate that various strategies which improve ventilation and establishes functional residual capacity early may further reduce the need for supplemental oxygen.…”

Section: Respiratory and Other Short-term Nicu Morbiditiesmentioning

confidence: 99%

“…We did not have a visual O 2 targeting system such as TOTS [Transitional Oxygen Targeting System] to help keep saturations within target range. 45 Our study is relevant to most resuscitation situations because the majority of the world' s neonates are resuscitated without a visual targeting system. This is the first randomized trial to use current NRPrecommended O 2 saturation targets in preterm infants needing DR resuscitation.…”

Section: Figurementioning

confidence: 99%

Resuscitation of Preterm Neonates With Limited Versus High Oxygen Strategy

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Preterm infants can be successfully resuscitated with ,100% oxygen (O 2 ); however, initiation with room air remains controversial. Current Neonatal Resuscitation Program (NRP) guidelines suggest using air or blended O 2 to titrate O 2 to meet target preductal saturation goals. WHAT THIS STUDY ADDS:This is the first trial to compare a limited O 2 strategy to target NRP-recommended transitional goal saturations versus a high O 2 strategy in preterm infants. The limited O 2 strategy decreased integrated excess oxygen and oxidative stress and improved respiratory outcomes. abstract OBJECTIVE: To determine whether a limited oxygen strategy (LOX) versus a high oxygen strategy (HOX) during delivery room resuscitation decreases oxidative stress in preterm neonates. METHODS:A randomized trial of neonates of 24 to 34 weeks' gestational age (GA) who received resuscitation was performed. LOX neonates received room air as the initial resuscitation gas, and fraction of inspired oxygen (FIO 2 ) was adjusted by 10% every 30 seconds to achieve target preductal oxygen saturations (SpO 2 ) as described by the 2010 Neonatal Resuscitation Program guidelines. HOX neonates received 100% O 2 as initial resuscitation gas, and FIO 2 was adjusted by 10% to keep preductal SpO 2 at 85% to 94%. Total hydroperoxide (TH), biological antioxidant potential (BAP), and the oxidative balance ratio (BAP/TH) were analyzed in cord blood and the first hour of life. Secondary outcomes included delivery room interventions, respiratory support on NICU admission, and short-term morbidities.RESULTS: Forty-four LOX (GA: 30 6 3 weeks; birth weight: 1678 6 634 g) and 44 HOX (GA: 30 6 3 weeks; birth weight: 1463 6 606 g) neonates were included. LOX decreased integrated excess oxygen (+FIO 2 3 time [min]) in the delivery room compared with HOX (401 6 151 vs 662 6 249; P , .01). At 1 hour of life, BAP/TH was 60% higher for LOX versus HOX neonates (13 [9-16] Dr Kapadia conceptualized and designed the study, recruited patients, and designed the data collection instruments; participated in collecting the data, analysis of the data, and interpretation of data; and drafted the initial manuscript, wrote the last draft of the manuscript, and approved the final manuscript as submitted. Dr Chalak participated in concept, design, analysis, and interpretation of data; reviewed and revised the manuscript; and approved the final manuscript as submitted. Dr Sparks participated in recruitment, design, analysis, and interpretation of data; and reviewed and approved the final manuscript as submitted. Mr Allen participated in design, data collection, and analysis of data; and reviewed and approved the final manuscript as submitted. Dr Savani participated in concept, design, analysis, and interpretation of data; and critically reviewed and approved the final manuscript as submitted. Dr Wyckoff participated in conceptualization and design of the study; supervised the recruitment, designing of data, and collection instruments; participated in analysis...

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Achieving Targeted Pulse Oximetry Values in Preterm Infants in the Delivery Room

Cited by 34 publications

References 16 publications

Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation

Pedi-cap color change precedes a significant increase in heart rate during neonatal resuscitation

Principles of pulse oximetry and its clinical application in neonatal medicine

Resuscitation of Preterm Neonates With Limited Versus High Oxygen Strategy

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