The Effect of Initial High vs. Low FiO 2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial

Frontiers in Pediatrics

article

Janneke Dekker¹  Arjan B. te Pas¹  Tessa Martherus¹  Enrico Lopriore¹  Martin Giera²  Erin V. McGillick³  Jeroen Hutten⁵  Ruud W. van Leuteren⁵  Anton H. van Kaam⁵  Stuart B. Hooper³ 

[1] Department of Neonatology, Leiden University Medical Center;Center Proteomics Metabolomics, Leiden University Medical Center;The Ritchie Centre, Hudson Institute for Medical Research;Department of Obstetrics and Gynaecology, Monash University;Department of Neonatology, Emma Children's Hospital, University of Amsterdam

关键词: preterm infant;    respiratory effort;    breathing;    oxygen;    resuscitation;   

DOI  :  10.3389/fped.2019.00504

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Background: Infants are currently stabilized at birth with initial low FiO 2 which increases the risk of hypoxia and suppression of breathing in the first minutes after birth. We hypothesized that initiating stabilization at birth with a high O 2 concentration, followed by titration, would improve breathing effort when compared to a low O 2 concentration, followed by titration. Methods: In a bi-center randomized controlled trial, infants 95%. 8-iso-prostaglandin F2α (8iPGF2α) was measured to assess oxidative stress in cord blood and 1 and 24 h after birth. Results: Fifty-two infants were randomized and recordings were obtained in 44 infants (100% O 2 -group: n = 20, 30% O 2 -group: n = 24). Minute volumes were significantly higher in the 100% O 2 -group (146.34 ± 112.68 mL/kg/min) compared to the 30% O 2 -group (74.43 ± 52.19 mL/kg/min), p = 0.014. Tidal volumes and MIFR were significantly higher in the 100% O 2 -group, while the duration of mask ventilation given was significantly shorter. Oxygenation in the first 5 min after birth was significantly higher in infants in the 100% O 2 -group [85 (64–93)%] compared to the 30% O 2 -group [58 (46–67)%], p < 0.001. The duration of hypoxemia was significantly shorter in the 100% O 2 -group, while the duration of hyperoxemia was not different between groups. There was no difference in oxidative stress marker 8iPGF2α between the groups. Conclusion: Initiating stabilization of preterm infants at birth with 100% O 2 led to higher breathing effort, improved oxygenation, and a shorter duration of mask ventilation as compared to 30% O 2 , without increasing the risk for hyperoxia or oxidative stress. Clinical Trial Registration: This study was registered in www.trialregister.nl , with registration number NTR6878.

【 授权许可】

CC BY