Does the use of 50% oxygen at birth in preterm infants reduce lung injury?

Harling, A E

doi:10.1136/adc.2004.059287

Cited by 48 publications

(34 citation statements)

References 20 publications

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“…In addition, oxidant stress has been reported with even relatively mild changes in supplemental oxygen (32). Furthermore, the inflammatory response to FiO 2 Ͼ50% does not change substantially (33). We also confirmed that ELBW premature infants exhibited biologic markers of oxidant stress (redox potential of glutathione, di-tyrosine, and iso-PG-F 2␣ ) that were significantly more oxidized than in adults (34), generally indicating a greater vulnerability to ROS-mediated tissue injury.…”

Section: Discussionsupporting

confidence: 73%

Inflammatory Response in Preterm Infants Is Induced Early in Life by Oxygen and Modulated by Total Parenteral Nutrition

Lavoie

Watson

et al. 2010

Pediatr Res

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The i.v. lipid emulsion (LIP) is a source of oxidants, which may stimulate inflammation. Coadministration of parenteral multivitamins (MVP) with LIP prevents lipid peroxidation in lightexposed total parenteral nutrition (TPN). We hypothesized that this modality of TPN administration affects systemic inflammation, which may be modulated by exposure to oxygen. Premature infants were allocated to three TPN regimens: control regimen -MVP coadministered with amino acid/dextrose exposed to ambient light, LIP provided separately (n ϭ 9) -LIPϩMVP light exposed (LE): MVP coadministered with light-exposed LIP (n ϭ 9) -LIPϩMVP light protected (LP): MVP coadministered with light-protected LIP (n ϭ 8). In LE and LP, amino acid/dextrose was provided separately. On reaching full TPN, infants were sampled for IL-6 and IL-8 in plasma and the redox potential of glutathione in whole blood (E, mV). Data were compared (ANOVA) in infants exposed to low (Ͻ0. S upplemental oxygen, assisted ventilation, and total parenteral nutrition (TPN) are therapies that expose premature infants to significant oxidant and inflammatory stress (1-4). As these infants are particularly deficient in antioxidant and anti-inflammatory defenses, such therapies may also have potentially harmful long-term effects on their developing lungs and brain (5).Synergistic deleterious effects of inflammation and oxidant stress in preterm infants can occur through a number of potential mechanisms. Exposure to oxygen leads to the accumulation of reactive oxygen species (ROS), which results in the generation of hydrogen and lipid peroxides. When antioxidant defenses are overwhelmed, this reaction self-propagates, and the peroxides generated can damage cells and tissues (6). In preterm infants, even brief periods of supplemental oxygen at birth may produce sufficient oxidant stress to cause sustained lung disease (7). Also, oxidized lipids and hydrogen peroxides have a direct modulatory effect on inflammatory pathways, including Toll-like receptors (8), and the transcriptional activator nuclear factor (NF)-kB (9). Such a direct activation of inflammatory pathways by oxygen byproducts can potentiate inflammatory responses and promote further endothelial injury and pulmonary capillary leakage, resulting in systemic generalization of the inflammation with potentially harmful consequences on the developing preterm brain (10). Hydrogen peroxides are markedly increased in brain tissues of animals exposed to hyperoxia (11). Oxidant stress and systemic inflammation each have independent and synergistic deleterious apoptotic effects on brain microglial cells and immature oligodendrocyte (12)(13)(14). Notably, prolonged supplemental oxygen exposure and systemic inflammation as measured by plasma levels of IL-6 and IL-8 have both been strongly associated with adverse long-term pulmonary and neurodevelopmental outcomes in preterm infants (15)(16)(17)(18)(19).Quality of nutrition early in life has documented beneficial effects on health outcomes later in life (20). Premature...

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Section: Discussionsupporting

confidence: 73%

Inflammatory Response in Preterm Infants Is Induced Early in Life by Oxygen and Modulated by Total Parenteral Nutrition

Lavoie

Watson

et al. 2010

Pediatr Res

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“…Close to one third of responders start resuscitation with a delivered oxygen concentration of 30 to 50%, a practice that is supported by some recent small randomized controlled trials despite the fact these trials were not sufficiently powered to evaluate the impact on long-term outcome. [19][20][21][22] There is likely to be clinical equipoise until new evidence is provided or the recommendation is further modified. It is worth noting that 10% of respondents still use 100% oxygen to initiate resuscitation, which may induce hyperoxia and oxidative stress-mediated end-organ damage.…”

Section: Discussionmentioning

confidence: 99%

Delivery room resuscitation of preterm infants in Canada: current practice and views of neonatologists at level III centers

El-Naggar

McNamara

2011

J Perinatol

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Objective: To explore physicians' experiences and views related to resuscitation practice of preterm infants at birth, and determine whether the Canadian modifications of 2006 Neonatal Resuscitation Program (NRP) guidelines have been accepted by neonatologists.Study Design: Neonatologists (n ¼ 146) at 25 tertiary neonatal intensive care units (NICUs) across Canada were contacted via email to participate in a web-based survey about their practice regarding resuscitation of preterm infants in the delivery room (DR).Result: In all, 78 respondents (53%) from 23 centres completed the survey. Participants reported significant variability in temperature control measures. Hypothermia, <36.5 1C on NICU admission, was reported by 49% of respondents. Room air is used by 59% of respondents to initiate resuscitation. The majority (91%) of participants use pulse oximetry to titrate oxygen administration. Although more than two thirds (69%) of respondents target an oxygen saturation range of 85 to 92%, 51% of respondents would allow 5 to 10 min for the oxygen saturation to reach the target level. Carbon dioxide detectors are commonly used to confirm endotracheal tube placement (90%). Although respondents (96%) agree on the use of positive end-expiratory pressure (PEEP), when providing positive pressure ventilation (PPV), only 60% would initiate PPV with a pre-set peak inspiratory pressure, mostly 20 cm H 2 O.Conclusion: DR resuscitation practices are highly variable in Canadian NICU's and the currently recommended NRP guidelines are not uniformly followed. Factors leading to variability and discordance in practice should be investigated to facilitate better compliance.

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“…23 Kumar et al 24 showed that resuscitation with air decreased oxidative stress in asphyxiated newborn lambs without increasing metabolic acidosis. There are now at least six small prospective randomized trials comparing the use of lower and higher oxygen concentrations during neonatal resuscitation in preterm infants [25][26][27][28][29][30] using targeted SpO 2 . These trials have compared lower versus higher initial oxygen concentrations and all evaluated short-term neonatal outcomes.…”

Section: Oxygen Use In the Drmentioning

confidence: 99%

Neonatal resuscitation for the preterm infant: evidence versus practice

Finer

Rich

2010

J Perinatol

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In an effort to determine the actual conduct of neonatal resuscitation and the errors that may be occurring during this process, we developed a method of video recording neonatal resuscitations as an ongoing quality assurance project. We initiated video recordings of resuscitations using simple video recorders attached to an overhead warmer and reviewed the resultant tapes during biweekly quality improvement meetings. We also added the continuous recording of analog information such as heart rate, oximeter values, fraction of inspired oxygen and airway pressure. We subsequently developed a checklist that includes a preresuscitation briefing and a postresuscitation debriefing, all of which are reviewed at the same time as the video recording. We have examined the use of oxygen in the very preterm infant, the effectiveness of bag and mask ventilation, including the detection of airway obstruction during such ventilation, intubation in the delivery area and environment. In addition, we have trained our teams and leaders using Crew Resource Management and focused on improved communication. The availability of a dedicated room for resuscitation allows an increased ambient environment and the ability to provide a userfriendly setting similar to the neonatal intensive care unit to optimize performance. There are numerous opportunities for improving team and leader performance and outcomes following neonatal resuscitation. Further prospective studies are required to evaluate specific interventions.

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Does the use of 50% oxygen at birth in preterm infants reduce lung injury?

Cited by 48 publications

References 20 publications

Inflammatory Response in Preterm Infants Is Induced Early in Life by Oxygen and Modulated by Total Parenteral Nutrition

Inflammatory Response in Preterm Infants Is Induced Early in Life by Oxygen and Modulated by Total Parenteral Nutrition

Delivery room resuscitation of preterm infants in Canada: current practice and views of neonatologists at level III centers

Neonatal resuscitation for the preterm infant: evidence versus practice

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