DOCSLIB.ORG

Original Article Oxygen for Newborns: How Much Is Too Much?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Original Article Oxygen for Newborns: How Much Is Too Much? Original Article Oxygen for Newborns: How Much is Too Much? Ola Didrik Saugstad, MD, PhD World Health Organization, the estimated global burden of birth asphyxia is between 4 and 9 million newborns out of 130 million births. It is estimated that the number of infants with asphyxia- related neurologic disability is around 1 million, and the number International guidelines for newborn resuscitation recommend the use of of neonatal deaths due to birth asphyxia is also in the range of 100% oxygen. However, high concentrations of oxygen after asphyxiation 1 million.4 In addition, there are approximately 1.6 million activate reactive oxygen species that may contribute to a number of intrapartum stillbirths and many of them are related to morbidities. Animal models have been useful in describing their intrauterine asphyxia. mechanisms, but only large-scale clinical trials can provide evidence that In 1999, an advisory statement from the Pediatric Working may be used to alter clinical practice. It has been demonstrated that Group of the International Liaison Committee on Resuscitation neonates recover faster when resuscitated with room air as opposed to pure said that 100% oxygen should be used for newborn resuscitation.5 oxygen and neonatal mortality rates are improved. Increases in saturation This statement is, in my opinion, outdated and no longer accurate. are equal with oxygen and room air resuscitation. Studies of normal oxygen There is a building body of evidence that suggests that room air is saturation immediately after birth suggest that clinicians may unnecessarily sufficient for neonatal resuscitation and that the use of pure be rushing to high saturations. In the first weeks of life, lower saturation oxygen generates oxygen radicals and may be toxic. However, large targets in preterm infants reduce retinopathy of prematurity and pulmonary clinical trials that satisfy the requirements of evidence-based complications and may improve growth. The neonatologist would be well medicine are still needed in this field. served to think of oxygen as a medication, and use it sparingly. Journal of Perinatology (2005) 25, S45–S49. doi:10.1038/sj.jp.7211321 Sources of Free Radicals Hypoxanthine accumulates during hypoxia, and during reoxygenation, superoxide radicals are produced.2,3 As more oxygen INTRODUCTION is given during resuscitation, more superoxide radicals are produced, leading to cell injury.2 Oxygen radicals are produced by Scheele and Priestley are credited with the discovery of oxygen, but a number of sources, not only by the hypoxanthine–xanthine 170 years before their publications, a Polish alchemist, Michael oxidase system. The most important source may be the Sendivogius, described a gas that could be obtained by heating 1 mitochondria in the electron transfer chain. Oxygen radicals are potassium nitrate. He called the gas ‘‘the elixir of life.’’ Ironically, also produced by activated macrophages and oxidation of in neonates suffering asphyxia, dispensing the ‘‘elixir of life’’ in its catecholamines and arachidonic acid. The hydroxyl radical is pure form activates toxic substances, ultimately resulting in cell 2,3 produced through Fenton chemistry, which might induce further death. It is this paradoxical role of oxygen in full-term and oxidation, protein oxidation, DNA damage and may also affect premature neonates that will be reviewed to better understand its signal transduction.6 application in resuscitation after asphyxia, the optimal saturation the first weeks of life, and considerations related to its overuse. There is a need for a greater respect for oxygen as an entity that An In Vivo Animal Model possesses both therapeutic and toxic characteristics, similar to A model of hypoxia/reoxygenation in pigs has been developed.7–10 prescribed medications. Piglets of 1 to 2 days old are exposed to 8% oxygen until they are Asphyxia is a devastating condition that causes morbidity and close to collapse. They are then resuscitated with either room air, mortality in neonates in a number of forms. According to the 100% oxygen, or any other oxygen concentration of interest to be studied. The system features ability to measure systemic and local hemodynamics and by applying microdialysis local metabolic Department of Pediatric Research, Rikshospitalet University Hospital, University of Oslo, Oslo, changes in the brain as well. The microcirculation in the brain Norway. may be measured by laser Doppler, and brain oxygenation Proprietary interest/disclosure: None. measured by oxygen probe. A nitric oxide sensor is also used in Address correspondence and reprint requests to Ola Didrik Saugstad, MD, PhD, Department of some studies to measure local nitric oxide concentrations. In this Pediatric Research, Rikshospitale, 0027 Oslo, Norway. model, pulmonary arterial blood pressure follows a biphasic pattern Journal of Perinatology 2005; 25:S45–S49 r 2005 Nature Publishing Group All rights reserved. 0743-8346/05 $30 www.nature.com/jp S45 Saugstad Oxygen for Newborns 11 during the hypoxemic phase. During resuscitation, there is a very SaO2 in 1 min Apgar < 4 rapid and high increase in the pulmonary arterial pressure, which 100 11 Room air is followed by a gradual normalization. 100% Oxygen Hydrogen peroxide from the sagittal sinus in these newborn 75 12 piglets has also been studied. Hydrogen peroxide concentration % 2 increases during resuscitation with 100% oxygen, and there is no 50 P= 0.003 increase in animals resuscitated with room air. These data agree SaO with a study by Kondo et al., in which the authors used a newborn 25 apneic piglet model, measuring the concentration of free radicals 13 0 on the lung surface for 6 minutes. Animals resuscitated with 1 3 room air had no increase in free radical production. Animal Min after birth models, therefore, consistently demonstrate that resuscitation of Figure 1. SaO2 at 1 and 3 minutes of life in asphyxiated neonates hypoxic neonates with 100% oxygen results in the production of with 1 minute Apgar score <4 resuscitated with room air and 100% free radicals, whereas resuscitation with room air does not induce oxygen. Data from the RESAIR 2 database. A small but significant higher SaO was noted in room air babies. free radical production. 2 Table 1 Time to First Cry in Minutes in Neonates Resuscitated with Room Air and 100% Oxygen; Results from Two Clinical Trials Clinical Trials: RESAIR 2 Saugstad et al.14 Ramji et al.15 The RESAIR 2 study enrolled approximately 600 infants in six countries in a multicenter clinical study of asphyxiated newborn 21% Oxygen 1.6 2.0 infants comparing their resuscitation with either room air or 100% 100% Oxygen 2.0 3.0 oxygen.14 Heart rate, one of the outcome parameters, was recorded p 0.005 0.008 for the first 30 minutes of life. There was no difference in heart rate between neonates resuscitated with 100% oxygen and neonates resuscitated with room air.14 More surprising, there was no This OR represents a 40% reduction in neonatal mortality difference in oxygen saturation between neonates resuscitated with associated with resuscitation with room air instead of 100% oxygen. 100% oxygen and room air. Oxygen saturation (SaO2) was Examining the cohort from Spain separately, neonatal mortality measured in a subset of infants and was approximately 60% at 1 was reduced from 3.5 to 0.5%. It is possible that this level of minute, and 80% at 3 minutes, and gradually increases up to 90% mortality is more representative of industrialized countries and at 10 minutes. Neonates resuscitated with room air had rather therefore reflects the situation in North America and Western similar oxygen saturation as those given 100% oxygen. Figure 1 Europe. Preterm neonates were also analyzed separately. Also, for shows SaO2 values in infants with 1 minute Apgar score <4. this group, neonatal mortality decreased significantly when infants Further, resuscitation with 100% oxygen delayed the time to first were resuscitated with room air (OR 0.51, 95% CI 0.28 to 0.90). cry14 (Table 1). The delay was in median 24 seconds in the Applying these rates of reductions in mortality to the occurrence RESAIR 2 study, and 60 seconds in a study by Ramji et al.15 of birth asphyxia, a 5% reduction in 4 million neonates worldwide Regarding neonatal mortality, neonates resuscitated with room suffering from birth asphyxia corresponds to 200,000 lives. If the air had a rate of 14% as compared to 19% in the group resuscitated 3% reduction from Spain is representative of North America and with 100% oxygen. One possible explanation of the high mortality Western Europe, both of which have 200,000 neonates annually rate in these infants is that most of these babies were enrolled from that require resuscitation, these figures imply the rescue of 6000 developing countries. The odds ratio (OR) of 0.69 (0.44 to 1.06) lives every year. was not significant, but there is a strong tendency in favor of Although the impact on outcomes seems to be evident, the room air.14 optimal oxygen concentration for resuscitation remains to be To date, five studies have been published including 1737 infants defined. In order to define the optimal level, the normal time- randomly assigned (or pseudorandomly assigned) to room air or course of oxygen saturation during first minutes postpartum must oxygen resuscitation. In a meta-analysis, we examined neonatal be known. Rao and Ramji17 published a study suggesting that mortality as the primary outcome parameter, and secondary normal newborn babies have a median or a mean oxygen parameters of heart rate, APGAR score and time to first breath.16 saturation of 70% at 1 minute of age, and that there is a large The meta-analysis found a reduction in neonatal mortality from variation in normal levels which include saturations as low as 40% 13% in the oxygen group to 8% in the room air group, giving ORs in normal healthy neonates.
Load more

Recommended publications
  • Newborn Transition and Neonatal Resuscitation
    NEWBORN TRANSITION AND NEONATAL RESUSCITATION LIMPOPO INIATIVE FOR NEWBORN CARE 2017 1 TABLE OF CONTENTS INTRODUCTION TO THE COURSE ON NEWBORN TRANSITION AND NEONATAL RESUSCITATION 4 COURSE OVERVIEW 4 HOW THE COURSE WORKS 4 COURSE DEVELOPERS AND FACILITATORS 4 MODULE 1: NEWBORN TRANSITION AND RESUSCITATION 6 MODULE 1: PREPARING FOR THE BIRTH 9 STEP 1: PREPARE AN EMERGENCY PLAN 9 STEP 2: HANDWASHING 9 STEP 3: PREPARE THE MOTHER AND BIRTH COMPANION FOR THE DELIVERY 11 STEP 4: PREPARE THE AREA FOR DELIVERY. 11 STEP 5: PREPARE FOR RESUSCITATION AND CHECK THE EMERGENCY EQUIPMENT. 11 SELF ASSSEMENT QUESTIONS: MODULE 1 15 MODULE 2: ROUTINE CARE AT BIRTH 16 DRY THOROUGHLY 16 CHECK IF THE BABY IS CRYING, CHECK BREATHING, KEEP WARM 16 CLAMP AND CUT THE CORD. 16 ROUTINE CARE OF BABIES BORN BY CAESAREAN SECTION 17 ROUTINE CARE OF PRETERM BABIES 17 MONITOR BABY WITH MOTHER AND INITIATE BREAST FEEDING 18 RAPIDLY ASSESS THE BABY IMMEDIATELY AFTER BIRTH 18 SELF ASSESSMENT QUESTIONS: MODULE 2 21 MODULE 3: HELP THE BABY WHO IS NOT BREATHING WELL 22 3. 1 CLEAR THE AIRWAY AND STIMULATE BREATHING. 22 3.2 VENTILATE WITH BAG AND MASK 23 3.3 IMPROVE VENTILATION IF THE BABY IS STILL NOT BREATHING WELL 24 SELF ASSESSMENT QUESTIONS: MODULE 3 25 MODULE 4. ADVANCED RESUSCITATION 26 4.1 PATHOPHYSIOLOGY OF BIRTH ASPHYXIA 26 4.2 ADVANCED CARE: HEART RATE 27 4.3 ENDOTRACHEAL INTUBATION 30 4.4 UMBILICAL VEIN CATHETERISATION 33 4.5 WHEN TO WITHHOLD OR DISCONTINUE LIFE SUPPORT 34 4.6 POST RESUSCITATION CARE OF THE NEONATE 35 SELF ASSESSMENT QUESTIONS MODULE 4 35 REFERENCES 37 CLINICAL PRACTICE SESSIONS 39 2 3 INTRODUCTION TO THE COURSE ON NEWBORN TRANSITION AND NEONATAL RESUSCITATION COURSE OVERVIEW The course is for doctors, midwives and clinical associates working in district and regional hospitals in South Africa.
    [Show full text]
  • Neonatal-Perinatal Medicine
    UT Southwestern Medical Center is widely recognized as one of the nation’s Neonatal leading centers for neonatal–perinatal care, teaching, and research. The Division is dedicated to providing exceptional care for the most critically ill patients and is committed to the training of outstanding physicians and scientists. Through the continued discovery of new knowledge, division faculty and staff strive to help tomorrow’s patients as well as improve outcomes for the vulnerable population for whom we care. - Perinatal Medicine Directed by Rashmin C. Savani, M.B.Ch.B., the Division of Neonatal-Perinatal Medicine is comprised of a large group of nationally and internationally recognized faculty members with expertise in virtually all aspects of modern neonatal-perinatal care and state-of-the-art research. The Division’s mission is to positively impact the health of neonates in our community, our nation, and worldwide through excellence in patient care, research, and education. That mission is three-fold: Rashmin C. Savani, M.B.Ch.B. Excellence in Neonatal Care Professor, Division Chief Through multidisciplinary and family-centered care, we will strive to improve the standard of practice and ensure the highest quality of care to neonates in our hospitals and around the world. We will care for neonates with the highest respect for their precious lives in a compassionate and caring environment and will utilize evidence-based approaches to clinical care that are regularly evaluated and updated. – 2019 Leadership in Research We will pursue new knowledge through high-quality research that explores unanswered questions, as well as tests and refines previously established ideas in neonatal-perinatal care.
    [Show full text]
  • Neonatal Resuscitation
    NEONATAL RESUSCITATION INTRODUCTION (DANA SUOZZO, M.D., 11/2015) Every 5 years the American Heart Association reviews the resuscitation literature and updates their recommendations. This PEM Guide reviews the updated guidelines for neonatal resuscitation. This PEM Guide includes the recommendations from 2010 that have not changed as well as those from the 2015 update. MAJOR 2015 RECOMMENDATIONS ECG is more accurate than auscultation in assessing heart rate immediately after delivery Delayed cord clamping is suggested for preterm neonates NOT requiring resuscitation at delivery There is insufficient data to support tracheal suctioning in a non-vigorous baby born with meconium as it delays ventilation Laryngeal mask airways can be used for > 34 week neonates if the clinician is unsuccessful with ventilating via a face mask and/or tracheal intubation There is not sufficient evidence for any delivery room prognostic score to help make decisions about < 25 week neonates. Presumed gestational age is the best guide In late preterm and term neonates, an APGAR of 0 and an undetectable heart rate after 10 minutes of effective resuscitation should prompt consideration of stopping resuscitation. Each case must be considered individually. Approximately 10% of newborns require some assistance to begin breathing at birth. Less than 1% requires extensive resuscitative measures. Those neonates who do not require resuscitation can generally be identified by a rapid assessment using 3 questions. 1. Is this a term gestation? 2. Does the neonate have good muscle tone? 3. Is the neonate crying or breathing? If the answer to all 3 of these questions is “yes,” the neonate does not need resuscitation and can stay with the mother for routine care.
    [Show full text]
  • Working Paper
    WORKING PAPER Prepared for the United Nations Commission on Life-Saving March 2012 Commodities for Women and Children This is a working document. It has been prepared to facilitate the exchange of knowledge and to stimulate discussion. The findings, interpretations and conclusions expressed in this paper are those of the authors and do not necessarily reflect the policies or views of the United Nations Commission on Life-Saving Commodities for Women and Children, or the United Nations. The text has not been edited to official publication standards, and the Commission accepts no responsibility for errors. The designations in this publication do not imply an opinion on legal status of any country or territory, or of its authorities, or the delimitation of frontiers. 1 CASE STUDY Newborn Resuscitation Devices Prepared for the United Nations Commission on Life-Saving February Commodities for Women and 2012 Children 2 Authors Patricia Coffey,1 Lily Kak,2 Indira Narayanan,3 Jen Bergeson Lockwood,2 Nalini Singhal,4 Steve Wall,5 Joseph Johnson,5 Eileen Schoen4 1PATH; 2United States Agency for International Development; 3consultant to PATH; 4American Academy of Pediatrics; 5Save the Children Acknowledgements The authors would like to thank the following individuals for their contributions: Olaolu Aderinola, Patrick Aliganyira, Norma Aly, Asma Badar, Sherri Bucher, Anna Chinombo, Elizabeth Dangaiso, Maria Isabel Degrandez, Todd Dickens, Ivonne Gómez, Abra Greene, Jorge Hermida, Jud Heugel, Miguel Hinojosa-Sandoval, Jessica Hulse, Nnenna Ihebuzor,
    [Show full text]
  • Neonatal Resuscitation
    High Impact Practice: Neonatal Resuscitation Neonatal resuscitation is a life-saving component of childbirth care and must be available at all births. It is estimated that complications during childbirth resulting in birth asphyxia contribute to 25% of all neonatal deaths and 50% of fresh stillbirths globally. Many more newborns are left with permanent brain injury. Fortunately, most of these deaths and disability can be prevented by quality care during labour and childbirth and by providing basic neonatal resuscitation. While basic neonatal resuscitation is a life-saving component of care at all births, recent assessments of health facilities in refugee sites show that many health facilities are not prepared to provide neonatal resuscitation – either they do not have the essential equipment available and/or health workers are not skilled in resuscitation. UNHCR Public Health Officers and implementing health partners must ensure that all health facilities that provide childbirth services have the capacity to provide basic neonatal resuscitation as part of their essential package of care. Reviewing the current level of readiness to provide neonatal resuscitation is recommended in all operations. Neonatal Resuscitation Approximately 10% of all newborns will require some assistance to begin breathing at birth. Less than 1% will require advanced resuscitation measures. Basic resuscitation includes: ✓ Initial assessment (APGAR score, term or preterm status) ✓ Open airway. Nasal and oral suctioning only when indicated. Routine suctioning is
    [Show full text]
  • Noninvasive Ventilation in the Delivery Room for the Preterm Infant
    Noninvasive Ventilation in the Delivery Room for the Preterm Infant Heather Weydig, MD,* Noorjahan Ali, MD, MS,* Venkatakrishna Kakkilaya, MD* *Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX Education Gaps The preterm lung is highly susceptible to injury from exposure to mechanical ventilation in the delivery room. It is important to use optimal noninvasive ventilation strategies and continuous positive airway pressure to establish functional residual capacity during resuscitation to avoid intubation and mechanical ventilation. Abstract A decade ago, preterm infants were prophylactically intubated and mechanically ventilated starting in the delivery room; however, now the shift is toward maintaining even the smallest of neonates on noninvasive respiratory support. The resuscitation of very low gestational age neonates continues to push the boundaries of neonatal care, as the events that transpire during the golden minutes right after birth prove ever more important for determining long-term neurodevelopmental outcomes. Continuous positive airway pressure (CPAP) remains the most important mode of noninvasive respiratory support for the preterm infant to establish AUTHOR DISCLOSURE Drs Weydig, Ali, and maintain functional residual capacity and decrease ventilation/perfusion and Kakkilaya have disclosed no financial relationships relevant to this article. This mismatch. However, the majority of extremely low gestational age infants commentary does not contain a discussion of require face mask positive pressure ventilation during initial stabilization an unapproved/investigative use of a commercial product/device. before receiving CPAP. Effectiveness of face mask positive pressure ventilation depends on the ability to detect and overcome mask leak and ABBREVIATIONS airway obstruction. In this review, the current evidence on devices and BPD bronchopulmonary dysplasia techniques of noninvasive ventilation in the delivery room are discussed.
    [Show full text]
  • Neonatal Resuscitation: an Update TALKAD S
    Neonatal Resuscitation: An Update TALKAD S. RAGHUVEER, MD, Wesley Medical Center and Pediatrix Medical Group of Kansas, Wichita, Kansas AUSTIN J. COX, MD, Tripler Army Medical Center, Honolulu, Hawaii Appropriate resuscitation must be available for each of the more than 4 million infants born annually in the United States. Ninety percent of infants transition safely, and it is up to the physician to assess risk factors, identify the nearly 10 percent of infants who need resuscitation, and respond appropriately. A team or persons trained in neonatal resus- citation should be promptly available to provide resuscitation. The Neonatal Resuscitation Program, which was initiated in 1987 to identify infants at risk of needing resuscitation and provide high-quality resuscitation, under- went major updates in 2006 and 2010. Among the most important changes are to not intervene with endotracheal suctioning in vigorous infants born through meconium-stained amniotic fluid (although endotracheal suctioning may be appropriate in nonvigorous infants); to provide positive pres- sure ventilation with one of three devices when necessary; to begin resuscitation of term infants using room air or blended oxygen; and to have a pulse oximeter readily available in the delivery room. The updated guidelines also provide indications for chest compressions and for the use of intravenous epinephrine, which is the preferred route of administration, and recommend not to use sodium bicar- bonate or naloxone during resuscitation. Other recommendations include confirming endotracheal tube placement using an exhaled carbon dioxide detector; using less than 100 percent oxygen and ade- quate thermal support to resuscitate preterm infants; and using ther- apeutic hypothermia for infants born at 36 weeks’ gestation or later with moderate to severe hypoxic-ischemic encephalopathy.
    [Show full text]
  • Surgery in Norway a Comprehensive Review at the 100-Year Jubilee of !E Norwegian Surgical Society 1911–2011
    Surgery in Norway A Comprehensive Review at the 100-year Jubilee of !e Norwegian Surgical Society 1911–2011 Internet-version - corrected according to suggestions from the members of the Norwegian Surgical Societies, who received a printed “working” version in 2011. Editors: Jon Ha!ner, Tom Gerner and Arnt Jakobsen Copyright 2011: The Norwegian Surgical Association, Oslo Internet version 2012 ISBN nr: 978-82-8070-093-3 Preface The Norwegian Surgical Society was founded on the First The present book is written by leading surgeons in the of August in 1911. The main reason was discontent with different specialties, and all the manuscripts have been the surgeons’ wages and working conditions, but in 1924 reviewed and commented on by other prominent surgeons the focus changed to the scientific aspects of surgery, and to ensure objectivity. membership was opened to surgeons in training. Since then the Society has had annual meetings with free presentations, The initial manuscript was printed and distributed to all mem- and debates about surgical methods, education, specialisa- bers of the surgical societies in Norway (totally 2250) in 2011 tion, leadership, and working conditions. The social aspect for corrections and comments. The present Internet edition has also been important, an annual dinner has been ar- has been corrected according to the comments received, and an ranged since 1925. extra chapter on former Chairmen and Boards of The Norwe- gian Surgical Society/ Assosciation has been added. In 2006 the Society was renamed The Norwegian Surgical Association, with the chairmen of the other surgical socie- The initial manuscript was printed and distributed to all ties as board members.
    [Show full text]
  • European Society for Paediatric Research Annual Meeting Abstracts Bilbao, Spain September 27–30, 2003
    0031-3998/03/5404-0557 PEDIATRIC RESEARCH Vol. 54, No. 4, 2003 Copyright © 2003 International Pediatric Research Foundation, Inc. Printed in U.S.A. EUROPEAN SOCIETY FOR PAEDIATRIC RESEARCH ANNUAL MEETING ABSTRACTS BILBAO, SPAIN SEPTEMBER 27–30, 2003 0008NEO 0011NEO PRESCHOOL OUTCOME IN CHILDREN BORN VERY PREMATURELY EFFICACY OF ERYTHROPOITIN IN PREMATURE INFANTS AND CARED FOR ACCORDING TO NIDCAP Adnan Amin, Daifulah Alzahrani Bjo¨rn Westrup1, Birgitta Bo¨hm1, Hugo Lagercrantz1, Karin Stjernqvist2 Alhada Military Hospital City:Taif, Saudi Arabia 1Neonatal Programme, Dept. of Woman and Child Health, Astrid Lindgren Children’s Hospital, Objective: To identify the effect of early of parentral recombinant human erythropoitin (r-HuEPO) Karolinska Institute, Stockholm, Sweden;2Depts. of Psychology and of Paediatrics, University of and iron administration on blood transfusion requirement of premature infants. Methods: In a Lund, Sweden City: Stockholm and Lund, Sweden controlled clinical trial conducted at the Neonatal Intensive Care Unit, Al-Hada Military Hospital, Background/aim: Care based on the Newborn Individualized Developmental Care and Assess- Taif, Kingdom of Saudi Arabia over a 16 month period. We assigned 20 very low birth weight infants ment Program (NIDCAP) has been reported to exert a positive impact on the development of (VLBW) with gestational age of (mean Ϯ SEM 28.4 Ϯ 0.5 weeks and birth weight of (mean Ϯ SEM prematurely born infants. The aim of the present investigation was to determine the effect of such care 1031 Ϯ 42 gm), to receive either intravenous (r-HuEPO 200 U/kg/day) and iron 1mg/kg/day or on the development at preschool age of children born with a gestational age of less than 32 weeks.
    [Show full text]
  • The First Golden Minute Ola Didrik Saugstad 2O Congreso Argentino
    The first Golden Minute Delivery room handling of newborn infants Ola Didrik Saugstad, MD, PhD, FRCPE University of Oslo and Oslo University Hospital Norway Email: odsaugstad@[email protected] 2o Congreso Argentino de Neonatologia, Buenos Aires, June 27-29, 20013 Delivery Room Stabilisation Delivery room management •Adequate preparation •Cord clamping •Free airways •Maintenance of neutral thermal environment •Appro priate use of supplemental oxygen •Non invasive respiratory support •Timely administration of surfactant •Teamwork and communication New European Guidelines On Management of RDS Sweet D et al Neonatology 2013;103:353-368 Outline of lecture •The golden minute(s) •Suctioning Vs wiping •Cord clamping •Thermal control •Oxygenation •CPAP/Surfactant •Gentle resuscitation/stabilization The Golden Minute: Helping Babies Breathe Drying/stimulating Suctioning Ventilation Assessment 10% need help to breathe within «the golden minute» ILCOR Neonatal Resuscitation Guidelines 2010 The golden minute Perlman J et al, Circulation 2010;122 (Suppl 2) S516-538 The Golden Minute(s) Cold and Oxygen Flow V PDA Ventilation Chorioamnionitis rate T Dry Gas Oxygen Antenatal Delivery Steroids Pregnancy Room Postnatal Care Outcome Managementt Pre-eclampsia Nutrition PEEP Surfactant Temp. Sepsis Nutrition Others control 5- 9 months 15-30 min Weeks ‐months years Modified from Alan Jobe Stabilization or resuscitation „Most premature babies are not dead and therefore do not need „resuscitation“ They need assistance in transition and adaptation
    [Show full text]
  • International Academy of Perinatal Medicine (Iapm)
    History, Organization and Activities PREFACE Organization and Activities History, he International Academy of Perina- by Prof. Erich Saling, President of IAPM. tal Medicine (IAPM) was created in T 2005, with the agreement of the Presi- FOREWORD dents of three scientific societies: the by José M. Carrera, Secretary General ) World Association of Perinatal Medicine of IAPM. (WAPM), the European Association of Peri- CHAPTER 1 natal Medicine (EAPM) and the Internatio- The History of Perinatal Medicine. nal Society «The Fetus as a Patient» (ISFAP). IAPM ( th On the 25 of May 2005 took place the CHAPTER 2 foundational ceremony in Barcelona The fathers of Perinatal Medicine: (Spain) with venue at the Royal Academy the academic medals. of Medicine of Catalonia. CHAPTER 3 The objective of the Academy is to create a Identity and mission of International place for the studystudy, reflection, dialogue Academy of Perinatal Medicine (IAPM). INTERNATIONAL and prpromotionomotion of PPerinatal Medicine, es- CHAPTER 4 pecially on those ississues related to bioethics, History of International Academy the appropriate appapplication of the techno- of Perinatal Medicine (IAPM): ACADEMY logical advances aand the sociologic and the foundation. huhumanisticmanistic ddimensionsimensi of the fi eld. CHAPTER 5 OF PERINATAL Furthermore, the AAcademy endeavours to Constitution of IAPM and By-Laws. constitute a friendshfriendship-based bond among ththee ththreeree scscientificientifi Societies that have CHAPTER 6 sponsored its foundfoundation. Basic Organization of the IAPM. MEDICINE In the same act oof the foundation, the CHAPTER 7 members of the BBoard of the Academy The International Council: were elected. Prof. Erich Saling (Germany) Regular Fellows of IAPM. (IAPM) was elected as President,Pre and Professors CHAPTER 8 Asim Kurjak (Croati(Croatia), Aris Antsaklis (Gree- Honorary Members ce), Frank ChervenaChervenak (USA) and H.
    [Show full text]
  • Neonatal Resuscitation: Evolving Strategies Payam Vali1,2*, Bobby Mathew1,2 and Satyan Lakshminrusimha1,2
    Vali et al. Maternal Health, Neonatology, and Perinatology (2015) 1:4 DOI 10.1186/s40748-014-0003-0 REVIEW Open Access Neonatal resuscitation: evolving strategies Payam Vali1,2*, Bobby Mathew1,2 and Satyan Lakshminrusimha1,2 Abstract Birth asphyxia accounts for about 23% of the approximately 4 million neonatal deaths each year worldwide (Black et al., Lancet, 2010, 375(9730):1969-87). The majority of newborn infants require little assistance to undergo physiologic transition at birth and adapt to extrauterine life. Approximately 10% of infants require some assistance to establish regular respirations at birth. Less than 1% need extensive resuscitative measures such as chest compressions and approximately 0.06% require epinephrine (Wyllie et al. Resuscitation, 2010, 81 Suppl 1:e260–e287). Transition at birth is mediated by significant changes in circulatory and respiratory physiology. Ongoing research in the field of neonatal resuscitation has expanded our understanding of neonatal physiology enabling the implementation of improved recommendations and guidelines on how to best approach newborns in need for intervention at birth. Many of these recommendations are extrapolated from animal models and clinical trials in adults. There are many outstanding controversial issues in neonatal resuscitation that need to be addressed. This article provides a comprehensive and critical literature review on the most relevant and current research pertaining to evolving new strategies in neonatal resuscitation. The key elements to a successful neonatal resuscitation include ventilation of the lungs while minimizing injury, the judicious use of oxygen to improve pulmonary blood flow, circulatory support with chest compressions, and vasopressors and volume that would hasten return of spontaneous circulation.
    [Show full text]