Initial Oxygen Use for Preterm Newborn Resuscitation: A Systematic Review With Meta-analysis

Welsford, Michelle; Nishiyama, Chika; Shortt, Colleen; Weiner, Gary M.; Roehr, Charles Christoph; Isayama, Tetsuya; Dawson, Jennifer A; Wyckoff, Myra H.; Rabi, Yacov

doi:10.1542/peds.2018-1828

Cited by 80 publications

(79 citation statements)

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“…Given the low-grade quality of the studies due to risk of bias and imprecision there is still uncertainty as to whether the use of higher or lower initial FiO 2 affects mortality, major morbidities or long-term neurodevelopmental disability in preterm infants (35). Welsford et al performed a systematic review and meta-analysis gathering evidence comparing different levels of FiO 2 employed to initiate resuscitation of preterm infants who require positive pressure ventilation in the DR (36). A total of 5697 preterm infants <35 weeks' gestation participating in 10 randomized/quasi randomized controlled and 4 retrospective observational cohort studies were analyzed.…”

Section: Comprehensive Updated Reviews and Meta-analysesmentioning

confidence: 99%

“…Higher initial FiO 2 was defined as ≥0.5, and lower <0.5. Results concluded that starting with either initial FiO 2 did not influence the primary outcome of short-term mortality [risk ratio (RR) 0.83, 95% confidence interval (CI) 0.50-1.37], long-term mortality, neurodevelopmental impairment, or other morbidities (36). It should be underscored that the meta-analysis included studies from 1980 to 2018 encompassing a wide range of different guidelines, study designs, devices, and gestational ages.…”

Section: Comprehensive Updated Reviews and Meta-analysesmentioning

confidence: 99%

“…Hence, the use of pulse oximetry and air/oxygen blender were not routinely started until late 90's. Welsford et al recognized relevant limitations to the review, especially due to the risk of bias and imprecision and concluded that the ideal initial FiO 2 for preterm infants is yet unknown and requires further investigation (36).…”

Section: Comprehensive Updated Reviews and Meta-analysesmentioning

confidence: 99%

“…Oxygen is driven from the maternal side to the fetus across the placental intervillous spaces by a positive partial pressure delta gradient of oxygen between mother and fetus. The delta gradient evolves along gestation until the third trimester when it stabilizes around 4-5 kPa (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). In parallel, the lung undergoes sequential structural changes from the canalicular stage at around 24-28 weeks of gestation to the saccular stage between 28 and 34 weeks, and finally reaches the alveolar stage in the last weeks of gestation.…”

Section: Introductionmentioning

confidence: 99%

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Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth

et al. 2020

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Fetal to neonatal transition entails cardiorespiratory, hemodynamic, and metabolic changes coinciding with the switch from placental to airborne respiration with partial pressures of oxygen of 4-5 kPa in utero raising to 8-9 kPa ex utero in few minutes. Preterm infants have immature lung and antioxidant defense system. Very preterm infants (<32 weeks' gestation) frequently require positive pressure ventilation and oxygen to establish lung aeration, a functional residual capacity, and overcome a tendency toward hypoxemia and bradycardia in the first minutes after birth. Recent studies have shown that prolonged bradycardia (heart rate <100 beats per minute) and/or hypoxemia (oxygen saturation <80%) are associated with increased mortality and/or intracranial hemorrhage. However, despite the accumulated evidence, the way in which oxygen should be supplemented in the first minutes after birth still has not yet been clearly established. The initial inspired fraction of oxygen and its adjustment within a safe arterial oxygen saturation range measured by pulse oximetry that avoids hyper-or-hypoxia is still a matter of debate. Herewith, we present a current summary aiming to assist the practical neonatologist who has to aerate the lung and establish an efficacious respiration in very preterm infants in the delivery room.

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Section: Comprehensive Updated Reviews and Meta-analysesmentioning

confidence: 99%

Section: Comprehensive Updated Reviews and Meta-analysesmentioning

confidence: 99%

Section: Comprehensive Updated Reviews and Meta-analysesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth

et al. 2020

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“…Maintain a warm delivery room of about 26 Celsius. Fio 2 if required is given at 30% in <28 weeks of gestation, for 28-31weeks gestation Fio 2 of 21-30% is used and in >32 weeks gestational age 21% Fio 2 is used [12,13]. The aim is to achieve an SpO 2 of 80% or more by the end of 5 minutes in order to reduce mortality and intracranial hemorrhage.…”

Section: Use Of Optimal Oxygen and Getting Cpap Into The Delivery Roomentioning

confidence: 99%

Neonatal Respiratory Distress Syndrome in a Nutshell

2019

JPNB

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Respiratory distress syndrome (RDS) is an important cause of mortality and morbidity in preterm neonates. With the increasing number of preterm deliveries globally according to the World Health Organization, it is imperative to consider a safe place for delivery and a good obstetric care to start with. Antenatal steroids are helpful not only in reducing the risk of RDS but also reducing necrotizing enterocolitis (NEC) and Intraventricular hemorrhage which further improves the outcome of a preterm delivery. Delayed cord clamping is recommended as it reduces mortality in preterm newborns. Use of optimal oxygen and getting CPAP into the delivery room has improved the outcome and reduced the need of mechanical ventilation thus reducing the risk of Chronic Lung Disease (CLD). Timing the administration of surfactant is important to avoid mechanical ventilation. The increasing use of non-invasive ventilation has reduced ventilator induced lung injury and CLD. Many have embraced Heated Humidified High Flow Nasal Oxygen (HHHFNC) as an alternative to CPAP and its use has increased in view of its ease of use and lesser trauma. Caffeine facilitates early extubation in intubated preemies on ventilators and improves neurodevelopment outcome. Adequate nutrition and proper temperature control starting from the point of delivery cannot be emphasized enough for this group of population.

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Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

et al. 2022

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IMPORTANCE Bronchopulmonary dysplasia (BPD) has multifactorial etiology and long-term adverse consequences. An umbrella review enables the evaluation of multiple proposed interventions for the prevention of BPD. OBJECTIVE To summarize and assess the certainty of evidence of interventions proposed to decrease the risk of BPD from published systematic reviews. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science were searched from inception until November 9, 2020. STUDY SELECTION Meta-analyses of randomized clinical trials comparing interventions in preterm neonates that included BPD as an outcome. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in duplicate. Quality of systematic reviews was evaluated using Assessment of Multiple Systematic Reviews version 2, and certainty of evidence was assessed using Grading of Recommendation, Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES (1) BPD or mortality at 36 weeks' postmenstrual age (PMA) and (2) BPD at 36 weeks' PMA.RESULTS A total of 154 systematic reviews evaluating 251 comparisons were included, of which 110 (71.4%) were high-quality systematic reviews. High certainty of evidence from high-quality systematic reviews indicated that delivery room continuous positive airway pressure compared with intubation with or without routine surfactant (relative risk [RR], 0.80 [95% CI, 0.68-0.94]), early selective surfactant compared with delayed selective surfactant (RR, 0.83 [95% CI, 0.75-0.91]), early inhaled corticosteroids (RR, 0.86 [95% CI, 0.75-0.99]), early systemic hydrocortisone (RR, 0.90 [95% CI, 0.82-0.99]), avoiding endotracheal tube placement with delivery room continuous positive airway pressure and use of less invasive surfactant administration (RR, 0.90 [95% CI, 0.82-0.99]), and volume-targeted compared with pressure-limited ventilation (RR, 0.73 [95% CI, 0.59-0.89]) were associated with decreased risk of BPD or mortality at 36 weeks' PMA. Moderate to high certainty of evidence showed that inhaled nitric oxide, lower saturation targets (85%-89%), and vitamin A supplementation are associated with decreased risk of BPD at 36 weeks' PMA but not the competing outcome of BPD or mortality, indicating they may be associated with increased mortality. CONCLUSIONS AND RELEVANCEA multipronged approach of delivery room continuous positive airway pressure, early selective surfactant administration with less invasive surfactant administration, early hydrocortisone prophylaxis in high-risk neonates, inhaled corticosteroids, and volume-targeted ventilation for preterm neonates requiring invasive ventilation may decrease the combined risk of BPD or mortality at 36 weeks' PMA.

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Initial Oxygen Use for Preterm Newborn Resuscitation: A Systematic Review With Meta-analysis

Cited by 80 publications

References 42 publications

Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth

Oxygen Supplementation During Preterm Stabilization and the Relevance of the First 5 min After Birth

Neonatal Respiratory Distress Syndrome in a Nutshell

Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

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