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PMID: 24218465 Published · ppublish English Journal Article Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't

Resuscitation of preterm neonates with limited versus high oxygen strategy.

Pediatrics ·Vol. 132 ·No. 6 ·2013-12-00 ·Pages e1488-96

Kapadia VS, Chalak LF, Sparks JE, Allen JR, Savani RC, Wyckoff MH

Abstract

To determine whether a limited oxygen strategy (LOX) versus a high oxygen strategy (HOX) during delivery room resuscitation decreases oxidative stress in preterm neonates. 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 (Fio2) was adjusted by 10% every 30 seconds to achieve target preductal oxygen saturations (Spo2) as described by the 2010 Neonatal Resuscitation Program guidelines. HOX neonates received 100% O2 as initial resuscitation gas, and Fio2 was adjusted by 10% to keep preductal Spo2 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. Forty-four LOX (GA: 30 ± 3 weeks; birth weight: 1678 ± 634 g) and 44 HOX (GA: 30 ± 3 weeks; birth weight: 1463 ± 606 g) neonates were included. LOX decreased integrated excess oxygen (∑Fio2 × time [min]) in the delivery room compared with HOX (401 ± 151 vs 662 ± 249; P < .01). At 1 hour of life, BAP/TH was 60% higher for LOX versus HOX neonates (13 [9-16] vs 8 [6-9]) µM/U.CARR, P < .01). LOX decreased ventilator days (3 [0-64] vs 8 [0-96]; P < .05) and reduced the incidence of bronchopulmonary dysplasia (7% vs 25%; P < .05). LOX is feasible and results in less oxygen exposure, lower oxidative stress, and decreased respiratory morbidities and thus is a reasonable alternative for resuscitation of preterm neonates in the delivery room.

Keywords
newborn oxidative stress oxygen preterm resuscitation
MeSH Terms
Antioxidants/metabolism Biomarkers/blood Female Free Radicals/blood Humans Infant, Newborn Infant, Premature/blood Infant, Premature, Diseases/epidemiology,etiology,prevention & control Intensive Care, Neonatal/methods Linear Models Male Oxidative Stress Oxygen/blood Oxygen Inhalation Therapy/adverse effects,methods Practice Guidelines as Topic Prospective Studies Respiration, Artificial/statistics & numerical data Resuscitation/adverse effects,methods
Chemicals
Antioxidants Biomarkers Free Radicals Oxygen
Authors & Affiliations
6 authors, click to expand affiliations / ORCID
Kapadia Vishal S
The University of Texas Southwestern Medical Center at Dallas, Department of Pediatrics, Division of Neonatal-Perinatal Medicine, 5323 Harry Hines Blvd, Dallas, TX 75390-9063. [email protected].
Chalak Lina F
Sparks John E
Allen James R
Savani Rashmin C
Wyckoff Myra H
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Article Info
Journal
Pediatrics
Abbr.
Pediatrics
ISSN
1098-4275
DOI
10.1542/peds.2013-0978
Email
[email protected]
Published
2013-12-00
Epub
2013-00-11
Pages
e1488-96
Language
English
Region
United States
NLM ID
0376422
PMCID
PMC3838529
Subset
IM
Grants
NICHD NIH HHS · K23 HD069521 · United States
NCATS NIH HHS · UL1 TR000451 · United States
NCATS NIH HHS · UL1 TR001105 · United States
NCATS NIH HHS · UL1TR000451 · United States
Databases
ClinicalTrials.gov
NCT01697904
Corrections
CommentIn
PMID: 24218459
External Links
PubMed source DOI: 10.1542/peds.2013-0978 PMC Full Text View journal details
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