Resuscitation of Preterm Neonates by Using Room Air or 100% Oxygen

Wang, Casey L.; Anderson, Christina; Leone, Tina A.; Rich, Wade; Govindaswami, Balaji; Finer, Neil N.

doi:10.1542/peds.2007-1460

Cited by 227 publications

(159 citation statements)

References 33 publications

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“…[16][17][18] There is a growing consensus among neonatologists regarding the need to reduce the FiO 2 in the delivery room, however, the question of the starting FiO 2 value remains a matter of debate. 19,20 Pulse oximetry as non-invasive, continuous technique allows to monitor peripheral arterial oxygenation saturation (SpO 2 ). In case of measurement over the right hand or wrist, this SpO 2 is representative of the oxygen saturation reaching the brain.…”

Section: Introductionmentioning

confidence: 99%

Near-Infrared Spectroscopy Measurements of Cerebral Oxygenation in Newborns during Immediate Postnatal Adaptation

Fauchère

Schulz

Haensse

et al. 2010

The Journal of Pediatrics

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Section: Introductionmentioning

confidence: 99%

Near-Infrared Spectroscopy Measurements of Cerebral Oxygenation in Newborns during Immediate Postnatal Adaptation

Fauchère

Schulz

Haensse

et al. 2010

The Journal of Pediatrics

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“…The eight studies retained for analysis included 1,500 patients, 772 in the oxygen group and 728 in the air group. [4][5][6][7][8][9][10][11][12] The exact distribution per country cannot be given because 18 patients originally reported by Saugstad et al 8 were counted twice and need to be subtracted; nevertheless, as originally reported, the distribution would be: India = 1,148; Egypt = 121; Philippines = 26; Estonia = 26; Spain = 85; Denmark = 69; Norway = 2; United States = 41. The risk of bias assessment is given in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…In their study, Wang et al reported that the incidence of grade III-IV intraventricular hemorrhage was 11% (2/18) in the room air group and 0% (0/23) in the 100% oxygen group, with a similar mortality in both groups (1/18 vs 1/23 for room air and 100% oxygen, respectively). 11 Based on this single small study, we can infer that 570 preterm neonates would be required to attempt to eliminate a difference of 5% (alpha value of 0.05, beta value of 0.2, and two-sided test) in the incidence of severe intraventricular hemorrhage. However, considering that neither Wang et al nor Escrig et al were able to stabilize premature newborns with room air, we are of the view that room air should not be the initial gas mixture used for resuscitation of premature newborns.…”

Section: Discussionmentioning

confidence: 96%

“…However, considering that neither Wang et al nor Escrig et al were able to stabilize premature newborns with room air, we are of the view that room air should not be the initial gas mixture used for resuscitation of premature newborns. 11,18 The trend towards a reduction in the number of patients who require tracheal intubation (RR 0.85; 95% CI = 0.69 to 1.05) if oxygen is used should be interpreted cautiously because the expertise/training of the resuscitators was not mentioned in half of the studies, and the resuscitators were blinded to the gas mixture for only two studies.…”

Section: Discussionmentioning

confidence: 99%

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No evidence for superiority of air or oxygen for neonatal resuscitation: a meta-analysis

Guay

Lachapelle

2011

Can J Anesth/J Can Anesth

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Purpose The aim of this meta-analysis was to re-evaluate the evidence in favour of oxygen or room air as the initial gas mixture for neonatal resuscitation in terms of the following outcomes: death, hypoxic/ischemic encephalopathy, need for tracheal intubation, and APGAR score-Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), and Respiration-at five minutes. Methods A search with no language restriction for all available controlled clinical trials (CCT) was conducted in PUBMED, Cochrane Central Register of Controlled Trials, and EMBASE. Data were extracted independently by the two investigators. Results Eight CCTs were retained for analysis. They included 1,500 patients, 772 in the oxygen group and 728 in the air group. The evidence is based mainly on quasirandomized studies (1,311/1,500) with unblinded resuscitators (1,421/1,500). The expertise/training of the resuscitators was unspecified for four of the eight studies. The risk ratio (RR) for death was 1.35 (95% confidence intervals [CI] = 0.97 to 1.88; P = 0.08; I-squared 0%). The RR for hypoxic/ischemic encephalopathy was 1.03 (95% CI = 0.86 to 1.23; P = 0.74; I-squared 0%). The RR for requiring a tracheal intubation was 0.85 (95% CI = 0.69 to 1.05 [random effects model]; P = 0.12; I-squared = 9.51%). Conclusions The literature is insufficient to make any statement regarding the superiority of oxygen or room air as the initial gas mixture for neonatal resuscitation. RésuméObjectif L'objectif de cette me´ta-analyse e´tait de re´e´valuer les donne´es probantes soutenant la supe´riorited e l'oxyge`ne ou de l'air ambiant en tant que me´lange gazeux initial pour la re´animation ne´onatale en termes des crite`res suivants : de´ce`s, ence´phalopathie hypoxique / ische´mique, besoin d'intubation trache´ale et score APGAR -Apparence (couleur de la peau), Pouls (fre´quence cardiaque), Grimace (irritabilite´re´flexe), Activite´(tonus musculaire) et Respiration -a`cinq minutes.

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“…42 However, contrary to that in late preterm and term neonates, there is not much evidence to support exact recommendations for the initial FiO 2 when very low birth weight infants need resuscitation at birth. There are presently three smaller randomized studies [44][45][46] and an observational study 47 published, and their findings suggest that the smallest infants should also be started with a low-oxygen approach. Findings of a recent study indicate that it is feasible to initiate delivery room stabilization with <100% oxygen in very low birth weight infants when the FiO 2 is being adjusted according to postductal SaO 2 values.…”

Section: Preterm Infantsmentioning

confidence: 99%

Why are we still using oxygen to resuscitate term infants?

Saugstad

2010

J Perinatol

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This article summarizes the historical background for the use of oxygen during newborn resuscitation and describes some of the research and the process of changing the previous practice from a high-to a low-oxygen approach. Findings of a recent Cochrane review suggest that more than 100 000 newborn lives might be saved globally each year by changing from 100 to 21% oxygen for newborn resuscitation. This estimate represents one of the largest yields for a simple therapeutic approach to decrease neonatal mortality in the history of pediatric research. Available data also suggest that, for the very low birth weight infant, use of the low-oxygen approach should be considered with the understanding that some of the smallest and sickest preterm neonates will need some level of oxygen supplementation during the first minutes of postnatal life. As more data are needed for the very preterm population, creation of strict guidelines for these infants would be premature at present. However, it can be stated that term and late preterm infants in need of resuscitation should, in general, be started on 21% oxygen, and if resuscitation is not started with 21% oxygen, a blender should be available, enabling the administration of the lowest FiO 2 possible to keep heart rate and SaO 2 within the target range. For extremely low birth weight infants, initial FiO 2 could be between 0.21 and 0.30 and adjusted according to the response in SaO 2 and heart rate.

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Resuscitation of Preterm Neonates by Using Room Air or 100% Oxygen

Abstract: Resuscitation with room air failed to achieve our target oxygen saturation by 3 minutes of life, and we recommend that it not be used for preterm neonates.

Cited by 227 publications

References 33 publications

Near-Infrared Spectroscopy Measurements of Cerebral Oxygenation in Newborns during Immediate Postnatal Adaptation

Near-Infrared Spectroscopy Measurements of Cerebral Oxygenation in Newborns during Immediate Postnatal Adaptation

No evidence for superiority of air or oxygen for neonatal resuscitation: a meta-analysis

Why are we still using oxygen to resuscitate term infants?

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