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Mamidi RR, McEvoy CT. Oxygen in the neonatal ICU: a complicated history and where are we now? Front Pediatr 2024; 12:1371710. [PMID: 38751747 PMCID: PMC11094359 DOI: 10.3389/fped.2024.1371710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024] Open
Abstract
Despite major advances in neonatal care, oxygen remains the most commonly used medication in the neonatal intensive care unit (NICU). Supplemental oxygen can be life-saving for term and preterm neonates in the resuscitation period and beyond, however use of oxygen in the neonatal period must be judicious as there can be toxic effects. Newborns experience substantial hemodynamic changes at birth, rapid energy consumption, and decreased antioxidant capacity, which requires a delicate balance of sufficient oxygen while mitigating reactive oxygen species causing oxidative stress. In this review, we will discuss the physiology of neonates in relation to hypoxia and hyperoxic injury, the history of supplemental oxygen in the delivery room and beyond, supporting clinical research guiding trends for oxygen therapy in neonatal care, current practices, and future directions.
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Affiliation(s)
- Rachna R. Mamidi
- Division of Neonatology, Oregon Health & Science University, Portland, OR, United States
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Chandra P, Sundaram V, Kumar P. Oxygen saturation centiles in healthy preterm neonates in the first 10 min of life: a prospective observational study. Eur J Pediatr 2023; 182:1637-1645. [PMID: 36708383 DOI: 10.1007/s00431-023-04838-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/29/2023]
Abstract
Current oxygen saturation targets in delivery room given by Neonatal Resuscitation Program (NRP) are essentially derived from term neonates. This prospective observational study was conducted in a level-III neonatal unit in preterm neonates (< 37 weeks) who did not receive resuscitation or supplemental oxygen to create centile charts for pre-ductal oxygen saturations using robust statistical modelling methods. Pre-ductal oxygen saturations (SPO2) were recorded from birth till 10 min of age using current generation Masimo pulse oximeters. Centile charts were created by generalized additive models. The change in oxygen saturations over time across subjects was modelled as a Bayesian linear regression mixed-effects model after including 'a priori' covariates. Oxygen saturation data was analysed in 180 subjects with mean gestation of 34 ± 2 weeks. Mean (SD) time to first SPO2 was 167 ± 77 s. The median time to SPO2 of > 90% was 310 s (IQR: 235-400). Time to > 90% SPO2 was shorter in (a) 34-36 weeks compared to < 34 weeks (290 vs 340; p = 0.03) and (b) vaginally delivered compared to caesarean-section born neonates (300 vs 360; p = 0.2). Conclusions: Oxygen saturations in first 10 min of age in healthy preterm neonates are significantly higher than the targets proposed by the NRP-2020. Larger preterm neonates and those born through vaginal route attained a preductal saturation of > 90% sooner. What is Known: • Pulse oximetry is the standard for oxygen saturation monitoring during immediate postnatal period. • Healthy term neonates take many minutes after birth to reach a pre-ductal saturation of >90%. But, postnatal oxygen saturation trend data in healthy preterm neonates are scarce. What is New: • Provides centile charts for oxygen saturations till 10 minutes of age using current generation Masimo pulse oximeters in a large cohort of healthy preterm neonates using robust statistical modelling methods. • Identifies covariates that significantly modifies the saturation trends using a Bayesian mixed models' regression.
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Affiliation(s)
- Purna Chandra
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
| | - Venkataseshan Sundaram
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012.
| | - Praveen Kumar
- Division of Neonatology, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India, 160012
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Lara-Cantón I, Badurdeen S, Dekker J, Davis P, Roberts C, Te Pas A, Vento M. Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping. Pediatr Res 2022:10.1038/s41390-021-01805-y. [PMID: 34997223 DOI: 10.1038/s41390-021-01805-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/03/2021] [Accepted: 10/06/2021] [Indexed: 01/10/2023]
Abstract
Blood oxygen in the fetus is substantially lower than in the newborn infant. In the minutes after birth, arterial oxygen saturation rises from around 50-60% to 90-95%. Initial respiratory efforts generate negative trans-thoracic pressures that drive liquid from the airways into the lung interstitium facilitating lung aeration, blood oxygenation, and pulmonary artery vasodilatation. Consequently, intra- (foramen ovale) and extra-cardiac (ductus arteriosus) shunting changes and the sequential circulation switches to a parallel pulmonary and systemic circulation. Delaying cord clamping preserves blood flow through the ascending vena cava, thus increasing right and left ventricular preload. Recently published reference ranges have suggested that delayed cord clamping positively influenced the fetal-to-neonatal transition. Oxygen saturation in babies with delayed cord clamping plateaus significantly earlier to values of 85-90% than in babies with immediate cord clamping. Delayed cord clamping may also contribute to fewer episodes of brady-or-tachycardia in the first minutes after birth, but data from randomized trials are awaited. IMPACT: Delaying cord clamping during fetal to neonatal transition contributes to a significantly earlier plateauing of oxygen saturation and fewer episodes of brady-and/or-tachycardia in the first minutes after birth. We provide updated information regarding the changes in SpO2 and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping. Nomograms in newborn infants with delayed cord clamping will provide valuable reference ranges to establish target SpO2 and HR in the first minutes after birth.
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Affiliation(s)
- Inmaculada Lara-Cantón
- Neonatal Research Group, Health Research Institute and University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Shiraz Badurdeen
- Newborn Research Center and Neonatal Services, The Royal Women´s Hospital, Melbourne, VIC, Australia
| | - Janneke Dekker
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Peter Davis
- Newborn Research Center and Neonatal Services, The Royal Women´s Hospital, Melbourne, VIC, Australia
| | - Calum Roberts
- Department of Paediatrics, Monash University, Clayton, VIC, Australia
| | - Arjan Te Pas
- Division of Neonatology, Department of Paediatrics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Máximo Vento
- Neonatal Research Group, Health Research Institute and University and Polytechnic Hospital La Fe, Valencia, Spain.
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Cardiovascular fetal-to-neonatal transition: an in silico model. Pediatr Res 2022; 91:116-128. [PMID: 33731808 DOI: 10.1038/s41390-021-01401-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/16/2020] [Accepted: 01/21/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Previous models describing the fetal-to-neonatal transition often lack oxygen saturation levels, homeostatic control mechanisms, phasic hemodynamic signals, or describe the heart with a time-varying elastance model. METHODS We incorporated these elements in the adapted CircAdapt model with the one-fiber model for myocardial contraction, to simulate the hemodynamics of the healthy term human fetal circulation and its transition during the first 24 h after birth. The fetal-to-neonatal model was controlled by a time- and event-based script of changes occurring at birth, such as lung aeration and umbilical cord clamping. Model parameters were based on and validated with human and animal data. RESULTS The fetal circulation showed low pulmonary blood flow, right ventricular dominance, and inverted mitral and tricuspid flow velocity patterns, as well as high mean ductus venosus flow velocity. The neonatal circulation showed oxygen saturation levels to gradually increase to 98% in the first 15 min after birth as well as temporary left ventricular volume overload. CONCLUSIONS Hemodynamics of the term fetus and 24-h-old neonate, as well as the events occurring directly after birth and the transition during the first 24 h after birth, were realistically represented, allowing the model to be used for educational purposes and future research. IMPACT With the addition of oxygen saturation levels, homeostatic pressure-flow control mechanisms, and the one-fiber model for myocardial contraction, a new closed-loop cardiovascular model was constructed to give more insight into the healthy term human fetal circulation and its cardiovascular transition during the first 24 h after birth. Extensive validation confirmed that the hemodynamics of the term fetus and the fetal-to-neonatal transition were realistically represented with the model. This well-validated and versatile model can serve as an education as well as a research platform for in silico investigation of fetal-to-neonatal hemodynamic changes under a wide range of physiological and pathophysiological conditions.
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Gottimukkala SB, Sotiropoulos JX, Lorente-Pozo S, Monti Sharma A, Vento M, Saugstad OD, Oei JL. Oxygen saturation (SpO2) targeting for newborn infants at delivery: Are we reaching for an impossible unknown? Semin Fetal Neonatal Med 2021; 26:101220. [PMID: 33674253 DOI: 10.1016/j.siny.2021.101220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
For more than 200 years, pure oxygen was given ad libitum to newborn infants requiring resuscitation. Due to oxidative stress and injury concerns, a paradigm shift towards using "less" oxygen, including air (21% oxygen) instead of pure (100%) oxygen, occurred about twenty years ago. A decade later, clinicians were advised to adjust fractional inspired oxygen (FiO2) to target oxygen saturations (SpO2) that were derived from spontaneously breathing, healthy, mature infants. Whether these recommendations are achievable, beneficial, harmful or redundant is uncertain. The underlying pathology leading to resuscitation varies between infants and may considerably alter an infant's response to supplemental oxygen. In this review, we summarize available evidence for the use of SpO2 monitoring at delivery for newborn infants, elucidate existing knowledge and service gaps, and suggest future research recommendations that will lead to the safest clinical strategies for this standard and important practice.
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Affiliation(s)
- Sasi Bhushan Gottimukkala
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia; Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia
| | | | | | | | | | | | - Ju Lee Oei
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia; Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia.
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Abedin S, Habboub LM, Salameh KK, Vellamgot A, Valappil R, Salim S, Elkabir NM. Oxygen saturation nomogram by pulse oximetry in the first 24 h of life. J Clin Neonatol 2021. [DOI: 10.4103/jcn.jcn_41_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Padilla-Sánchez C, Baixauli-Alacreu S, Cañada-Martínez AJ, Solaz-García Á, Alemany-Anchel MJ, Vento M. Delayed vs Immediate Cord Clamping Changes Oxygen Saturation and Heart Rate Patterns in the First Minutes after Birth. J Pediatr 2020; 227:149-156.e1. [PMID: 32710909 DOI: 10.1016/j.jpeds.2020.07.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/24/2020] [Accepted: 07/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To build arterial oxygen saturation (SpO2) and heart rate (HR) percentiles for the first 10 minutes after birth in term infants born after an uneventful gestation, vaginal delivery, and delayed cord clamping (DCC) for ≥60 seconds, and to compare our results with previous ones constructed after immediate cord clamping. STUDY DESIGN Preductal SpO2, HR, and timing of DCC immediately after complete fetal body expulsion were recorded. The pulse-oximeter was adjusted in the right wrist/hand and set at maximal intensity and measurements performed every 2 seconds. RESULTS A total of 282 term newborn infants were included. The definitive data set comprised of 70 257 SpO2 and 79 746 HR measurements. Median and IQR of SpO2 (%) at 1, 5, and 10 minutes after birth were 77 (68-85), 94 (90-96), and 96 (93-98), respectively. HR (beats per minute) median and IQR at 1, 5, and 10 minutes after birth were 148 (84-170), 155 (143-167), and 151 (142-161), respectively. We found significantly higher SpO2 for the 10th, 50th, and 90th percentiles compared with the previous reference ranges for the first 5 minutes and HR for the first 1-2 minutes after birth. CONCLUSIONS Spontaneously breathing term newborn infants born by vaginal delivery who underwent DCC ≥60 seconds achieved higher SpO2 and HR in the first 5 minutes after birth compared with term neonates born under the same conditions but with immediate cord clamping. Further studies in neonates undergoing cesarean delivery are under way.
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Affiliation(s)
- Celia Padilla-Sánchez
- University and Polytechnic Hospital La Fe, Valencia, Spain; University of Valencia (UV), Spain; Generalitat Valenciana, Consellería de Salut, Unidad Docente de Matronas, Spain
| | - Susana Baixauli-Alacreu
- University and Polytechnic Hospital La Fe, Valencia, Spain; University of Valencia (UV), Spain; Generalitat Valenciana, Consellería de Salut, Unidad Docente de Matronas, Spain
| | | | | | | | - Máximo Vento
- University and Polytechnic Hospital La Fe, Valencia, Spain; Nursing and Midwifery School of the Valencian Community, Spain.
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Orpak ÜS, Ergin H, Çıralı C, Özdemir ÖMA, Koşar Can Ö, Çelik Ü. Comparison of cut and intact cord milking regarding cerebral oxygenation, hemodynamic and hematological adaptation of term infants. J Matern Fetal Neonatal Med 2019; 34:2259-2266. [PMID: 31475597 DOI: 10.1080/14767058.2019.1662781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Although both delayed umbilical cord clamping and intact umbilical cord milking (I-UCM) provide the effective placental transfusion at birth, these procedures may not be used in neonates needing resuscitation. The aim of this study is to investigate the effect of cut umbilical cord milking (C-UCM), which permits resuscitation during an immediate transition period (ITP). METHODS Sixty-two healthy term infants were randomly divided into C-UCM and I-UCM groups at birth. Approximately 30-cm length of cord was milked towards the baby 2-4 times within 20 seconds after birth in both C-UCM and I-UCM groups while the umbilical cord was cut in the former, and intact in the latter. Heart rate, arterial oxygen saturation (SpO2), cerebral regional oxygen saturation (crSO2) (2nd-15th min), blood pressure (BP) (within 15-30 min), residual placental blood volume (RPBV), and hemoglobin levels (at the sixth hour) were monitored during ITP. RESULTS There were no significant differences in terms of mean gestational age (w) [(39.0 ± 1.2) versus (38.8 ± 1.1)], birth weight (g) [(3351.45 ± 254.30) versus (3256.94 ± 285.52)], Apgar scores at the 5th min (10 ± 0 versus 10 ± 0), first breathing time (sec) (5.4 ± 3.8 versus 5.7 ± 4.1), SpO2, crSO2, BP (mmHg) [(52.9 ± 6.9) versus (51.8 ± 5.7)], hemoglobin levels (g/dl) [(17.7 ± 1.8) versus (18.4 ± 1.4)], and RPBV (ml/kg) [(23.9 ± 4.7) versus (22.9 ± 5.4)] between C-UCM and I-UCM groups (p > .05). CONCLUSION This study showed that C-UCM is as effective as I-UCM on cerebral oxygenation, hemodynamic and hematological adaptation of term infants in ITP. We suggest that C-UCM can provide additional placental transfusion in term neonates exposed to early cord clamping.
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Affiliation(s)
- Ümmühan Seda Orpak
- Division of Neonatology, Department of Pediatrics, Pamukkale University School of Medicine, Denizli, Turkey
| | - Hacer Ergin
- Division of Neonatology, Department of Pediatrics, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ceren Çıralı
- Division of Neonatology, Department of Pediatrics, Pamukkale University School of Medicine, Denizli, Turkey
| | - Özmert M A Özdemir
- Division of Neonatology, Department of Pediatrics, Pamukkale University School of Medicine, Denizli, Turkey
| | - Özlem Koşar Can
- Department of Obstetrics and Gynecology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ülker Çelik
- Division of Neonatology, Department of Pediatrics, Government Hospital, Denizli, Turkey
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Abstract
Low- and middle-income countries and resource-limited regions are major contributors to perinatal and infant mortality. Oxygen is widely used for resuscitation in high- and middle-income settings. However, oxygen supplementation is not available in resource-limited regions. Oxygen supplementation for resuscitation at birth has adverse effects in human/animal model studies. There has been a change with resultant recommendations for restrictive oxygen use in neonatal resuscitation. Neonatal resuscitation without supplemental oxygen decreases mortality and morbidities. Oxygen in resource-limited settings for neonatal resuscitation is ideal as a backup for selected resuscitations but should not be a limiting factor for implementing basic life-saving efforts.
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Rodríguez López J, García Lara NR, López Maestro M, De la Cruz Bértolo J, Martínez Ávila JC, Vento M, Parra Llorca A, Izquierdo Macián I, Pellicer A, Marín Huarte N, Asla Elorriaga I, Román Echevarría L, Copons Fernández C, Martín Ancel A, Cabañas F, García Algar Ó, Pallás Alonso CR. What is the impact of mother's bed incline on episodes of decreased oxygen saturation in healthy newborns in skin-to-skin contact after delivery: Study protocol for a randomized controlled trial. Trials 2019; 20:179. [PMID: 30894206 PMCID: PMC6427856 DOI: 10.1186/s13063-019-3256-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/27/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Early mother-child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn's prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns' breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother's bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. METHODS The study participants will be full-term healthy mother-newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother's bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO2 ≤ 90%. Secondary outcomes are the mean SO2 level, the number of newborns who experience episodes of SO2 ≤ 85%, the time to SSC discontinuation due to abnormal SO2 or HR, and episodes of HR < 111 beats per minute (bpm) or > 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. DISCUSSION A simple intervention such as modifying mother's bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn's hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. TRIAL REGISTRATION ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. PROTOCOL VERSION 2 (30th June 2015).
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Affiliation(s)
- Jesús Rodríguez López
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Nadia Raquel García Lara
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - María López Maestro
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | - Javier De la Cruz Bértolo
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
| | | | - Máximo Vento
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Ana Parra Llorca
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Isabel Izquierdo Macián
- Neonatology Department, La Fe University Hospital, Avenida de Fernando Abril Martorell, 106, 46026 València, Spain
| | - Adelina Pellicer
- Neonatology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Natalia Marín Huarte
- Neonatology Department, La Paz University Hospital, Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Izaskun Asla Elorriaga
- Neonatology Department, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya Spain
| | - Lourdes Román Echevarría
- Neonatology Department, Cruces University Hospital, Plaza de Cruces, S/N, 48903 Baracaldo, Vizcaya Spain
| | - Cristina Copons Fernández
- Neonatology Department, Vall d’Hebron University Hospital, Passeig de la Vall d’Hebron, 119-129, 08035 Barcelona, Spain
| | - Ana Martín Ancel
- Neonatology Department, San Joan de Déu University Hospital, Passeig de Sant Joan de Déu, 2, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Fernando Cabañas
- Neonatology Department, Quironsalud Madrid University Hospital, Calle Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Óscar García Algar
- Maternal, Fetal and Neonatal Department, Hospital Sant Joan de Déu- Clínic University Hospital, Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Carmen Rosa Pallás Alonso
- Neonatology Department, 12 de Octubre, University Hospital, Avenida de Córdoba s/n, 28041 Madrid, Spain
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Arroyo Cabrales L, Bernal Zamudio A, Fernández Carrocera L, Romero Maldonado S. Valores de saturación periférica de oxígeno por oximetría de pulso en recién nacidos de término sin patología respiratoria. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2017. [DOI: 10.1016/j.rprh.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Oxygen Saturation and Heart Rate Ranges in Very Preterm Infants Requiring Respiratory Support at Birth. J Pediatr 2017; 182:41-46.e2. [PMID: 27939259 DOI: 10.1016/j.jpeds.2016.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 09/20/2016] [Accepted: 11/03/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the changes in preductal oxygen saturation (SpO2) and heart rate in preterm infants receiving continuous positive airway pressure (CPAP) and/or positive-pressure ventilation (PPV) at birth. STUDY DESIGN A prospective observational study at birth of infants aged <32 weeks separated into 2 gestational age (GA) groups: 230/7-276/7 weeks (group 1) and 280/7-316/7 weeks (group 2). Infants received delayed cord clamping (DCC) in accordance with institutional protocol. CPAP and/or PPV was applied at the clinical team's discretion. SpO2 and heart rate were recorded every minute for 10 minutes. Preductal SpO2 was targeted according to published nomograms. For heart rate, the goal was to maintain a stable heart rate >100 bpm. RESULTS The study cohort comprised 96 group 1 infants (mean GA, 26 ± 1 weeks; mean birth weight, 818 ± 208 g) and 173 group 2 infants (mean GA, 30 ± 1 weeks; mean birth weight, 1438 ± 374 g). In general, infants requiring respiratory support reached target values for heart rate and SpO2 more slowly than the published nomograms for spontaneously breathing preterm infants without respiratory support. Infants receiving CPAP reached SpO2 and heart rate targets faster than infants receiving PPV. In group 1, but not group 2 infants, DCC resulted in higher SpO2 and heart rate. CONCLUSION SpO2 and heart rate do not quickly and reliably reach the values achieved by spontaneously breathing preterm infants not requiring respiratory support.
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Bancalari A, Araneda H, Echeverría P, Alvear M, Romero L. Arterial oxygen saturation and heart rate after birth in newborns with and without maternal bonding. Pediatr Int 2016; 58:993-997. [PMID: 27037834 DOI: 10.1111/ped.12991] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/20/2016] [Accepted: 02/29/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of this study was to determine and compare changes in arterial oxygen saturation (SpO2 ) and heart rate (HR) in healthy term infants with and without maternal bonding. METHOD This was a prospective observational study in healthy term infants. SpO2 and HR were recorded from 1 to 10 min after birth. After this, SpO2 and HR were registered at 15, 30 and 60 min and then at 12 and 24 h after birth. SpO2 and HR were measured with a pulse oximeter. RESULTS A total of 216 healthy term infants were divided into three different groups: 136 (63%) born by vaginal delivery, 56 (26%) born by cesarean section with bonding, and 24 (11%) born by cesarean section without bonding. No difference in SpO2 was found in babies born by cesarean section with or without maternal bonding. In neonates delivered vaginally, SpO2 was significantly higher during the first 10 min after birth than in neonates born by cesarean section with bonding (P < 0.05). Compared with infants born by cesarean section without bonding, this tendency was not significant. In general, HR was similar across groups, although, for infants born by cesarean section, neonates who received bonding had lower HR from 6 to 8 min (P < 0.05). CONCLUSIONS In healthy term newborns, maternal bonding in infants born by cesarean section did not have effects on SpO2 . Some differences were observed in HR between infants born by cesarean section with and without bonding.
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Affiliation(s)
- Aldo Bancalari
- Departments of Pediatrics, University of Concepción, Concepción, Chile.
| | - Heriberto Araneda
- Department of Obstetrics and Gynecology, University of Concepción, Concepción, Chile
| | - Patricia Echeverría
- Department of Childcare Neonatology Service, University of Concepción, Guillermo Grant Benavente Hospital, Concepción, Chile
| | - Marina Alvear
- Department of Childcare Neonatology Service, University of Concepción, Guillermo Grant Benavente Hospital, Concepción, Chile
| | - Luzmira Romero
- Department of Childcare Neonatology Service, University of Concepción, Guillermo Grant Benavente Hospital, Concepción, Chile
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Narayen IC, Blom NA, Bourgonje MS, Haak MC, Smit M, Posthumus F, van den Broek AJM, Havers HM, te Pas AB. Pulse Oximetry Screening for Critical Congenital Heart Disease after Home Birth and Early Discharge. J Pediatr 2016; 170:188-92.e1. [PMID: 26746119 DOI: 10.1016/j.jpeds.2015.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 10/23/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess the feasibility of pulse oximetry (PO) screening in settings with home births and very early discharge. We assessed this with an adapted protocol in The Netherlands. STUDY DESIGN PO screening was performed in the Leiden region in hospitals and by community midwives. Measurements were taken ≥ 1 hour after birth and on day 2 or 3 during the midwife visit. Primary outcome was the percentage of screened infants with parental consent. The time point of screening, oxygen saturation, false positive (FP) screenings, critical congenital heart defects (CCHDs), and other detected pathology were registered. RESULTS In a 1-year period, 3625 eligible infants were born. Parents of 491 infants were not approached for consent, and 44 refused the screening. PO screening was performed in 3059/3090 (99%) infants with obtained consent. Median (IQR) time points of the first and second screening were 1.8 (1.3-2.8) and 37 (27-47) hours after birth. In 394 infants with screening within 1 hour after birth, the median pre- and postductal oxygen saturations were 99% (98%-100%) and 99% (97%-100%). No CCHD was detected. The FP prevalence was 1.0% overall (0.6% in the first hours after birth). After referral, important noncritical cardiac and other noncardiac pathology was found in 62% of the FP screenings. CONCLUSIONS PO screening for CCHD is feasible after home births and very early discharge from hospital. Important neonatal pathology was detected at an early stage, potentially increasing the safety of home births and early discharge policy.
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Affiliation(s)
- Ilona C Narayen
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique C Haak
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Marrit Smit
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Fennie Posthumus
- Cooperation of Community Midwives in the Leiden Region (LEO), Leiden, The Netherlands
| | | | - Hester M Havers
- Department of Pediatrics, Alrijne Hospital, Leiderdorp, The Netherlands
| | - Arjan B te Pas
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
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Abstract
Infants admitted to health-care centers with acute bronchiolitis are frequently monitored with a pulse oximeter, a noninvasive method commonly used for measuring oxygen saturation. The decision to hospitalize children with bronchiolitis has been largely influenced by pulse oximetry, despite its questionable diagnostic value in delineating the severity of the illness. Many health-care providers lack the appropriate clinical fundamentals and limitations of pulse oximetry. This deficiency in knowledge might have been linked to changes in the management of bronchiolitis. The aim of this paper is to provide the current evidence on the role of pulse oximetry in bronchiolitis. We discuss the history, fundamentals of operation, and limitations of the apparatus. A search of the Google Scholar, Embase, Medline, and PubMed databases was carried out for published articles covering the use of pulse oximetry in bronchiolitis.
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Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics, General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar ; Weill-Cornell Medical College, Doha, Qatar
| | - Fatima A Jomha
- School of Pharmacy, Lebanese International University, Khiara, Lebanon
| | - Ahmed H Alhammadi
- Department of Pediatrics, General Pediatrics Division, Hamad Medical Corporation, Doha, Qatar ; Weill-Cornell Medical College, Doha, Qatar
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Narayen IC, Smit M, van Zwet EW, Dawson JA, Blom NA, te Pas AB. Low signal quality pulse oximetry measurements in newborn infants are reliable for oxygen saturation but underestimate heart rate. Acta Paediatr 2015; 104:e158-63. [PMID: 25601647 DOI: 10.1111/apa.12932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/01/2014] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Abstract
AIM We assessed the influence of system messages (SyMs) on oxygen saturation (SpO2 ) and heart rate measurements after birth to see whether clinical decision-making changed if clinicians included SyM data. METHODS The heart rate and SpO2 of term infants were recorded using Masimo pulse oximeters. Differences in means and standard deviations (SD) were calculated. Permutation corrected the nonrandom distribution and intersubject variation. SpO2 and heart rate centile charts were computed with, and without, SyMs. RESULTS Pulse oximetry measurements from 117 neonates provided 28 477 data points. SyMs occurred in 46% of measurements. Low signal quality accounted for 99.9% of SyMs. The mean SpO2 was lower with SyMs (p < 0.001), while the SpO2 SD was similar to data without SyMs. The SpO2 centile charts were approximately 2% lower with SyMs included, but they were not more dispersed. Mean heart rate was lower (p < 0.001) and more dispersed (p < 0.001) when a SyM occurred. The heart rate centile charts were lower, with increased variability, when SyMs were included. CONCLUSION A SyM occurred frequently during pulse oximetry in term infants after birth. SpO2 measurements with low signal quality proved reliable for monitoring an infant's clinical condition. However, heart rate could be underestimated by low signal quality measurements.
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Affiliation(s)
- Ilona C. Narayen
- Department of Neonatology; Leiden University Medical Center; Leiden the Netherlands
| | - Marrit Smit
- Department of Obstetrics; Leiden University Medical Center; Leiden the Netherlands
| | - Erik W. van Zwet
- Department of Medical Statistics; Leiden University Medical Center; Leiden the Netherlands
| | | | - Nico A. Blom
- Department of Pediatric Cardiology; Leiden University Medical Center; Leiden the Netherlands
| | - Arjan B. te Pas
- Department of Neonatology; Leiden University Medical Center; Leiden the Netherlands
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17
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Lu YC, Wang CC, Lee CM, Hwang KS, Hua YM, Yuh YS, Chiu YL, Hsu WF, Chou YL, Huang SW, Lee YJ, Fan HC. Reevaluating reference ranges of oxygen saturation for healthy full-term neonates using pulse oximetry. Pediatr Neonatol 2014; 55:459-65. [PMID: 24875236 DOI: 10.1016/j.pedneo.2014.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 12/17/2013] [Accepted: 02/05/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We compared our clinical experience with currently available reference oxygen saturation level (SpO(2)) values from the American Academy of Pediatrics/American Heart Association (AAP/AHA) neonatal resuscitation program guidelines. METHODS We enrolled 145 healthy full-term neonates; infants showing respiratory distress and those with serious congenital anomalies were excluded. SpO(2) values at every 1 minute until 10 minutes after birth were measured and recorded. Infants were classified into the cesarean section (CS) and normal spontaneous delivery (NSD) groups for evaluating differences. The 10(th) percentiles of SpO(2) at each minute were used as the lower limits of normal oxygen saturation, and these were compared with the lowest target values recommended in the AAP/AHA guidelines. RESULTS Overall, 130 vigorous full-term neonates (median gestational age: 38 5/7 weeks; body weight at birth: 2405-3960 g) were analyzed. The median SpO(2) were 67% and 89% at the 1(st) and 4(th) minute, respectively. On average, SpO(2) values reached >90% at the 5(th) minute. No statistical differences were noted in the SpO(2) values between the CS and NSD groups after 5 minutes; however, a trend of higher SpO(2) was observed in the NSD group. We noted a gradually increasing trend for SpO(2) values over time, similar to that noted in the AAP/AHA guidelines. However, SpO(2) values at the 10(th) percentiles of each minute within the first 5 minutes in our study were equal to or significantly lower than those in the AAP/AHA guidelines; moreover, at the 10(th) minute, SpO(2) values at the 10(th) percentiles were significantly higher than those in the guidelines. CONCLUSION The delivery modes did not affect the SpO(2) values of full-term healthy neonates. Discrepancies in SpO(2) changes in full-term neonates not requiring resuscitation between this study and the AAP/AHA guidelines were significant. SpO(2) ranges for each time point within the first 10 minutes after birth should therefore be reevaluated locally.
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Affiliation(s)
- Ying-Chun Lu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan; Graduate Institute of Basic Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chuen-Ming Lee
- Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Kwei-Shuai Hwang
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, Taipei, Taiwan
| | - Yi-Ming Hua
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yeong-Seng Yuh
- Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yu-Lung Chiu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Ling Chou
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shao-Wei Huang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yih-Jing Lee
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Hyttel-Sorensen S, Hessel TW, la Cour A, Greisen G. A comparison between two NIRS oximeters (INVOS, OxyPrem) using measurement on the arm of adults and head of infants after caesarean section. BIOMEDICAL OPTICS EXPRESS 2014; 5:3671-83. [PMID: 25360381 PMCID: PMC4206333 DOI: 10.1364/boe.5.003671] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/29/2014] [Accepted: 09/03/2014] [Indexed: 05/09/2023]
Abstract
Previously the NIRS oximeter OxyPrem was calibrated by comparison to the INVOS in a blood-lipid phantom. The aim of the present study was to test this calibration clinically. During vasculur occlusions in 10 adults and after birth in 25 term infants the relationship was OxyPrem = 1.24 x INVOS - 23.6% and OxyPrem = 1.15 x INVOS - 16.2% on the adult arm and infant head, respectively. The precsion during steady state was 4.0% (CI 3.4% to 4.6%) and 3.4% (CI 2.9% to 3.9%) on the arm, and 6.7% (CI 5.9% to 7.6%) and 4.7% (CI 3.5% to 5.9%) on the infant head for OxyPrem and INVOS, respectively. We conclude that the calibration on the blood-lipid phantom was unsuccessful in achieving agreement in clinical measurements.
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Smit M, Dawson JA, Ganzeboom A, Hooper SB, van Roosmalen J, te Pas AB. Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact. Arch Dis Child Fetal Neonatal Ed 2014; 99:F309-14. [PMID: 24688080 DOI: 10.1136/archdischild-2013-305484] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess whether defined reference ranges of oxygen saturation (SpO₂) and heart rate (HR) of term infants after birth also apply for infants born after midwifery supervised uncomplicated vaginal birth, where delayed cord clamping (DCC) and immediate skin to skin contact (ISSC) is routine management. DESIGN Prospective observational study. SETTING AND PATIENTS Infants born vaginally after uncomplicated birth, that is, no augmentation, maternal pain relief or instrumental delivery. INTERVENTIONS Midwives supervising uncomplicated birth at home or in hospital in the Leiden region (The Netherlands) used an oximeter and recorded SpO₂ and HR in the first 10 min after birth. MAIN OUTCOME MEASURES SpO₂ and HR values were compared to the international defined reference ranges. RESULTS In Leiden, values of 109 infants were obtained and are comparable with previously defined reference ranges, except for a higher SpO₂ (p<0.05) combined with a slower increase in the first 3 min. The Leiden cohort also had a lower HR (p<0.05) during the first 10 min with a slower increase in the first 3 min. In the first minutes after birth, tachycardia (HR>180 bpm) occurred less often, and a bradycardia (<80 bpm) more often (p<0.05). CONCLUSIONS Defined reference ranges can be used in infants born after uncomplicated vaginal birth with DCC and ISSC, but higher SpO₂ and lower HR were observed in the first minutes.
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Kumar P, Yamada NK, Fuerch JH, Halamek LP. The neonatal resuscitation program: current recommendations and a look at the future. Indian J Pediatr 2014; 81:473-80. [PMID: 24652267 DOI: 10.1007/s12098-013-1332-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/27/2013] [Indexed: 10/25/2022]
Abstract
The Neonatal Resuscitation Program (NRP) consists of an algorithm and curriculum to train healthcare professionals to facilitate newborn infants' transition to extrauterine life and to provide a standardized approach to the care of infants who require more invasive support and resuscitation. This review discusses the most recent update of the NRP algorithm and recommended guidelines for the care of newly born infants. Current challenges in training and assessment as well as the importance of ergonomics in the optimization of human performance are discussed. Finally, it is recommended that in order to ensure high-performing resuscitation teams, members should be selected and retained based on objective performance criteria and frequent participation in realistic simulated clinical scenarios.
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Affiliation(s)
- Praveen Kumar
- Division of Newborn Medicine, Department of Pediatrics, Batson Children's Hospital, The University of Mississippi Medical Center, Jackson, MS, 39216-4505, USA,
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21
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Bhandankar M, Patil VD, Vidyasagar D. Oxygen saturation immediately after birth in infants delivered in tertiary care hospital in India. Indian J Pediatr 2014; 81:254-6. [PMID: 23824696 DOI: 10.1007/s12098-013-1126-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 06/05/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the sequential changes in SpO2 values in newborns delivered in a teaching hospital in India. METHODS Full-term infants born by normal vaginal delivery to registered mothers at KLE University Hospital, Belgaum with birth weight more than 2,500 g, no congenital anomalies and who had received only routine care at birth were included in the study. After delivery, newborn infants were placed on a resuscitation trolley under a radiant warmer; the oxygen saturation sensor was attached (Nellcor DURA-Y multisite oxygen sensor) and then connected to the monitor (Planet 55 multiparameter recorder). RESULTS The mean (SD) gestational age of infants included in the study was 38.8 (1.1) wk and birth weight was 2,800 (300) g. The median (IQR) oxygen saturation level (SpO2) at 2 min of age was 69 % (68 %-79 %). The median level of SpO2 at 90 % and 95 % saturation was attained at 6.5 min and at 11 min of life, respectively. CONCLUSIONS Infants delivered in resource poor facilities of developing countries take 11 min to reach 95 % saturations after birth but they are within the reference range values of Neonatal Resuscitation Program 2010 guidelines.
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Affiliation(s)
- Manisha Bhandankar
- Department of Pediatrics, KLE University's JN Medical College, Belgaum, 590010, Karnataka, India,
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22
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Vento M, Hummler H, Dawson J, Escobar J, Kuligowski J. Use of Oxygen in the Resuscitation of Neonates. OXIDATIVE STRESS IN APPLIED BASIC RESEARCH AND CLINICAL PRACTICE 2014. [DOI: 10.1007/978-1-4939-1405-0_11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
Pulse oximetry is increasingly being used in the delivery room. Expert recommendations state that oxygen therapy during newborn resuscitation should be guided by pulse oximetry. Obtaining accurate and stable oxygen saturation and heart rate information from a pulse oximeter in the delivery room can be challenging. Understanding the properties of this device is important in overcoming these challenges. This article describes several aspects of pulse oximetry use in the delivery room ranging from technical issues with the device itself to clinical applications of the technology.
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Affiliation(s)
- Yacov Rabi
- Division of Neonatology, Department of Paediatrics, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
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Dawson JA, Saraswat A, Simionato L, Thio M, Kamlin COF, Owen LS, Schmölzer GM, Davis PG. Comparison of heart rate and oxygen saturation measurements from Masimo and Nellcor pulse oximeters in newly born term infants. Acta Paediatr 2013; 102:955-60. [PMID: 23800004 DOI: 10.1111/apa.12329] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/03/2013] [Accepted: 06/19/2013] [Indexed: 12/01/2022]
Abstract
AIM To compare heart rate (HR) measurements from Masimo and Nellcor pulse oximeters (POs) against HR measured via a three lead electrocardiograph (ECG) (HRECG ). We also compared peripheral oxygen saturation (SpO2 ) measurements between Nellcor and Masimo oximeters. METHOD Term infants born via elective caesarean section were studied. ECG leads were placed on the infant's chest and abdomen. Masimo and Nellcor PO sensors were randomly allocated to either foot. The monitors were placed on a trolley, and data from each monitor screen captured by a video camera. HR, SpO2 measurements and signal quality were extracted. Bland-Altman analysis was used to determine agreement between HR from the ECG and each oximeter, and between SpO2 from the oximeters. RESULTS We studied 44 infants of whom 4 were resuscitated. More than 8000 pairs of observations were used for each comparison of HR and SpO2. The mean difference (±2SD) between HRECG and HRN ellcor was -0.8 (±11) beats per minute (bpm); between HRECG and HRM asimo was 0.2 (±9) bpm. The mean (±2SD) difference between SpO2Masimo and SpO2Nellcor was -3 (±15)%. The Nellcor PO measured 20% higher than the Masimo PO at SpO2 <70%. CONCLUSION Both oximeters accurately measure HR. There was good agreement between SpO2 measurements when SpO2 ≥70%. At lower SpO2 , agreement was poorer.
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Affiliation(s)
| | - A Saraswat
- Department of Obstetrics and Gynaecology; The University of Melbourne; Melbourne; Vic; Australia
| | - L Simionato
- Department of Obstetrics and Gynaecology; The University of Melbourne; Melbourne; Vic; Australia
| | - M Thio
- Neonatal Services; The Royal Women's Hospital; Melbourne; Vic; Australia
| | - COF Kamlin
- Neonatal Services; The Royal Women's Hospital; Melbourne; Vic; Australia
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Smit M, Ganzeboom A, Dawson JA, Walther FJ, Bustraan J, van Roosmalen JJM, te Pas AB. Feasibility of pulse oximetry for assessment of infants born in community based midwifery care. Midwifery 2013; 30:539-43. [PMID: 23866687 DOI: 10.1016/j.midw.2013.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 06/09/2013] [Accepted: 06/11/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE to evaluate the feasibility of using pulse oximetry (PO) for evaluating infants born in community-based midwifery care. DESIGN a prospective, observational study of infants born after midwifery supervised (home) births. SETTING 27 midwives from seven practices providing primary care in (home) births used PO at birth or the early puerperal period over a ten-month period. Data were obtained on the effect of PO on outcome, interventions and decision-making. Midwives were surveyed about applicability and usefulness of PO. PARTICIPANTS 153 infants born in primary midwifery care. FINDINGS all births were uncomplicated except for one infant receiving supplemental oxygen and another was mask ventilated. In 138/153 (90%) infants PO was successfully used and 88% of midwives found PO easy to use. In 148/153 (97%) infants PO did not influence midwives' clinical judgment and referral policy. In 5/153 (3%) infants, midwives were uncertain of the infant's condition, but PO measurements were reassuring. In case of suboptimal neonatal condition or resuscitation, 100% of midwives declared they would use PO again. KEY CONCLUSIONS it is feasible to use PO in community based midwifery care, but not considered an important contribution to routine evaluation of infants. Midwives would like to have PO available during suboptimal neonatal condition or when resuscitation is required. IMPLICATIONS FOR PRACTICE PO can be applied in community based midwifery care; it does not lead to insecurity or extra referral. Further research on a larger group of infants must show the effect of PO on neonatal outcomes.
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Affiliation(s)
- Marrit Smit
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
| | - Angelina Ganzeboom
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jennifer A Dawson
- Neonatal Services, The Royal Women's Hospital, Newborn Research - 7th Floor, Parkville Victoria, Melbourne, Australia.
| | - Frans J Walther
- Department of Paediatrics, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
| | - Jacqueline Bustraan
- PLATO, Centre for Research and Development in Education and Training, Faculty of Social Sciences, Pieter de la Courtgebouw, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Jos J M van Roosmalen
- Department of Obstetrics, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands; Department of Medical Humanities, EMGO Institute VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - Arjan B te Pas
- Department of Paediatrics, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
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Trevisanuto D, Gizzi C, Martano C, Dal Cengio V, Ciralli F, Torielli F, Villani PE, Di Fabio S, Quartulli L, Giannini L. Oxygen administration for the resuscitation of term and preterm infants. J Matern Fetal Neonatal Med 2013; 25 Suppl 3:26-31. [PMID: 23016614 DOI: 10.3109/14767058.2012.712344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Oxygen has been widely used in neonatal resuscitation for about 300 years. In October 2010, the International Liaison Committee on Neonatal Resuscitation released new guidelines. Based on experimental studies and randomized clinical trials, the recommendations on evaluation and monitoring of oxygenation status and oxygen supplementation in the delivery room were revised in detail. They include: inaccuracy of oxygenation clinical assessment (colour), mandatory use of pulse oximeter, specific saturation targets and oxygen concentrations during positive pressure ventilation in preterm and term infants. In this review, we describe oxygen management in the delivery room in terms of clinical assessment, monitoring, treatment and the gap of knowledge.
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Affiliation(s)
- Daniele Trevisanuto
- Children and Women's Health Department, Medical School University of Padua, Azienda Ospedaliera Padova, Padua, Italy.
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27
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Janata P, Edwards WH. A novel sonification strategy for auditory display of heart rate and oxygen saturation changes in clinical settings. HUMAN FACTORS 2013; 55:356-372. [PMID: 23691831 DOI: 10.1177/0018720812455433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The aim of this study was development of a sonification scheme to convey deviations in heart rate and oxygen saturation from a desired target level. BACKGROUND Maintaining physiologic parameters, such as oxygen saturation, within desired ranges, is challenging in many clinical situations. High rates of false positive alarms in clinical settings limit the utility of the alarms that trigger when thresholds are exceeded. Auditory displays that consider the semantic connotations of sounds and the processing limitations of human perception and cognition may improve monitoring. METHOD Across two experiments, clinical practitioners were tested on their ability to (a) discriminate pairs of sounds (two-note discrimination task), (b) infer and discern the intended physiological connotation of each acoustic attribute (name-the-variable task), and (c) categorize the amount of change in an implied physiological variable into three levels of change: none, small, and large (change-magnitude task). RESULTS Considerable variation in performance was observed across the set of practitioners, ranging from near-perfect performance on all tasks, even with no prior exposure to the stimuli, to failure to reach a target accuracy criterion of 87.5% after -80 min of training. On average, performance was well above chance on the name-the-variable and change-magnitude tasks during initial exposure and reached criterion within -20 min of training on each task. CONCLUSION The described sonification strategy may effectively communicate information about current heart rate and oxygen saturation status relative to desired target levels. APPLICATION The results can be applied to clinical monitoring settings in which a stream of discrete auditory informational items is indicated.
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Affiliation(s)
- Petr Janata
- Center for Mind and Brain, Department of Psychology, University of California, Davis, 267 Cousteau Pl., Davis, CA, USA.
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Noori S, Wlodaver A, Gottipati V, McCoy M, Schultz D, Escobedo M. Transitional changes in cardiac and cerebral hemodynamics in term neonates at birth. J Pediatr 2012; 160:943-8. [PMID: 22244465 DOI: 10.1016/j.jpeds.2011.12.008] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Revised: 10/26/2011] [Accepted: 12/08/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To describe cardiac function, cerebral regional oxygen saturation (rSO(2)), and cerebral blood flow (CBF) that correspond to changes in arterial oxygen saturation (SaO(2)) in normal term neonates immediately after birth and after the transition. STUDY DESIGN In this prospective observational study, cardiac function and cerebral hemodynamics were assessed by echocardiography and Doppler ultrasonography 3 times during the first 20 minutes after vaginal delivery, then again at 24-48 hours after delivery. Cerebral rSO(2) (by near-infrared spectroscopy) and preductal SaO(2) (by pulse oximetry) were assessed continuously. RESULTS In 20 neonates, SaO(2) increased progressively from 65% at 1 minute after birth to 97% at 17 minutes after birth. Cerebral rSO(2) increased from 47% at 1 minute to 83% at 8 minutes, then decreased progressively to 73% at 20 minutes. Middle cerebral artery mean velocity decreased from 34 cm/s at 7 minutes to 25 cm/s at 14 minutes. The patent ductus arteriosus (PDA) shunt was balanced at 5 minutes but became increasingly left to right. Left ventricular stroke volume was increased. Middle cerebral artery mean velocity demonstrated an inverse relationship with the PDA shunt. Further hemodynamic changes were noted on the posttransitional assessment. CONCLUSION After birth, ductal shunting rapidly changes from balanced to left to right, with a responsive increase in left ventricular stroke volume. Cerebral rSO(2) increases as SaO(2) rises during the first 8 minutes, subsequently, it decreases due to a drop in CBF and despite a further increase in SaO(2). The reduction in CBF is likely due to an increase in arterial O(2) content, PDA shunting, or both.
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Affiliation(s)
- Shahab Noori
- Department of Pediatrics, Children's Hospital, Los Angeles, CA, USA.
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Dawson JA, Vento M, Finer NN, Rich W, Saugstad OD, Morley CJ, Davis PG. Managing oxygen therapy during delivery room stabilization of preterm infants. J Pediatr 2012; 160:158-61. [PMID: 21907350 DOI: 10.1016/j.jpeds.2011.07.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 06/23/2011] [Accepted: 07/27/2011] [Indexed: 11/13/2022]
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Abstract
The introduction of pulse oximetry in clinical practice has allowed for simple, noninvasive, and reasonably accurate estimation of arterial oxygen saturation. Pulse oximetry is routinely used in the emergency department, the pediatric ward, and in pediatric intensive and perioperative care. However, clinically relevant principles and inherent limitations of the method are not always well understood by health care professionals caring for children. The calculation of the percentage of arterial oxyhemoglobin is based on the distinct characteristics of light absorption in the red and infrared spectra by oxygenated versus deoxygenated hemoglobin and takes advantage of the variation in light absorption caused by the pulsatility of arterial blood. Computation of oxygen saturation is achieved with the use of calibration algorithms. Safe use of pulse oximetry requires knowledge of its limitations, which include motion artifacts, poor perfusion at the site of measurement, irregular rhythms, ambient light or electromagnetic interference, skin pigmentation, nail polish, calibration assumptions, probe positioning, time lag in detecting hypoxic events, venous pulsation, intravenous dyes, and presence of abnormal hemoglobin molecules. In this review we describe the physiologic principles and limitations of pulse oximetry, discuss normal values, and highlight its importance in common pediatric diseases, in which the principle mechanism of hypoxemia is ventilation/perfusion mismatch (eg, asthma exacerbation, acute bronchiolitis, pneumonia) versus hypoventilation (eg, laryngotracheitis, vocal cord dysfunction, foreign-body aspiration in the larynx or trachea). Additional technologic advancements in pulse oximetry and its incorporation into evidence-based clinical algorithms will improve the efficiency of the method in daily pediatric practice.
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Affiliation(s)
- Sotirios Fouzas
- Respiratory Unit, Department of Pediatrics, University Hospital of Patras, Rio, 265 04 Patras, Greece.
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31
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Airway Management and Mask Ventilation of the Newborn Infant. ARC and NZRC Guideline 2010. Emerg Med Australas 2011; 23:428-35. [DOI: 10.1111/j.1742-6723.2011.01442_11.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Introduction to Resuscitation of the Newborn Infant. ARC and NZRC Guideline 2010. Emerg Med Australas 2011; 23:419-23. [DOI: 10.1111/j.1742-6723.2011.01442_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rabi Y, Singhal N, Nettel-Aguirre A. Room-air versus oxygen administration for resuscitation of preterm infants: the ROAR study. Pediatrics 2011; 128:e374-81. [PMID: 21746729 DOI: 10.1542/peds.2010-3130] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We conducted a blinded, prospective, randomized control trial to determine which oxygen-titration strategy was most effective at achieving and maintaining oxygen saturations of 85% to 92% during delivery-room resuscitation. METHODS Infants born at 32 weeks' gestation or less were resuscitated either with a static concentration of 100% oxygen (high-oxygen group) or using an oxygen-titration strategy starting from a concentration of 100% (moderate-oxygen group), or 21% oxygen (low-oxygen group). In the moderate- and low-oxygen groups, the oxygen concentration was adjusted by 20% every 15 seconds to reach a target oxygen saturation range of 85% to 92%. Treatment failure was defined as a heart rate slower than 100 beats per minute for longer than 30 seconds. RESULTS The moderate-oxygen group spent a greater proportion of time in the target oxygen saturation range (mean: 0.21 [95% confidence interval: 0.16-0.26]) than the high-oxygen group (mean: 0.11 [95% confidence interval: 0.09-0.14]). Infants in the low-oxygen group were 8 times more likely to meet the criteria for treatment failure than those in the high-oxygen group (24% vs 3%; P = .022). The 3 groups did not differ significantly in the time to reach the target oxygen saturation range. CONCLUSIONS Titrating from an initial oxygen concentration of 100% was more effective than giving a static concentration of 100% oxygen in maintaining preterm infants in a target oxygen saturation range. Initiating resuscitation with 21% oxygen resulted in a high treatment-failure rate.
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Affiliation(s)
- Yacov Rabi
- Division of Neonatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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Normal oxygen saturation trend in healthy term newborns within 30 minutes of birth. Indian J Pediatr 2011; 78:817-20. [PMID: 21409523 DOI: 10.1007/s12098-011-0405-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2010] [Accepted: 03/01/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine normal arterial oxygen saturation (SpO(2)) trend during first 30 min of life and to evaluate for difference in SpO(2) trends in healthy term newborns of normal vaginal delivery (NVD) and elective cesarean section (CS). METHODS This Prospective Cross-sectional Observational study was conducted in Department of Pediatrics and Obstetrics, Gandhi Medical College, Bhopal. Newborns born of NVD and elective CS in first 30 min of life, complying with the study criteria were included in the study. Soon after birth, newborns with Apgar score ≥ 7 were given routine care and pulse-oximeter probe was applied on wiped right hand continuously for 30 min. Readings were obtained at an interval of 5 min. RESULTS Among NVD, the mean SpO(2) at 1, 5, 10, 15, 20, 25 and 30 min were 64.26%, 76.23%, 86.05%, 90.78%, 91.41%, 91.73% and 93.48%, respectively. The mean SpO(2) for CS was 67.43%, 78.50%, 88.44%, 90.81%, 91.46%, 91.83% and 92.88%, respectively. There was no significant difference in the SpO(2) between NVD and CS [95% CI = 74.8612-94.8359 in NVD and 77.1231-94.6912 in CS] and the correlation between NVD and CS being significant [r = 0.997 at 0.01 level]. There exists a strong positive correlation between Apgar and SpO(2) [r = 0.995, significant at 0.01 level (1-tailed) in NVD and r = 0.980, significant at 0.01 level (2-tailed) in CS]. CONCLUSIONS The study defines the normal SpO(2) in healthy term newborns of NVD and CS delivered newborns and also concludes that there is no significant difference in SpO(2) among NVD and CS.
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Kiremitci S, Tuzun F, Yesilirmak DC, Kumral A, Duman N, Ozkan H. Is gastric aspiration needed for newborn management in delivery room? Resuscitation 2011; 82:40-4. [DOI: 10.1016/j.resuscitation.2010.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2010] [Revised: 07/30/2010] [Accepted: 09/01/2010] [Indexed: 02/04/2023]
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Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, Guinsburg R, Hazinski MF, Morley C, Richmond S, Simon WM, Singhal N, Szyld E, Tamura M, Velaphi S. Part 11: Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S516-38. [PMID: 20956259 DOI: 10.1161/circulationaha.110.971127] [Citation(s) in RCA: 458] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, Hazinski MF, Halamek LP, Kumar P, Little G, McGowan JE, Nightengale B, Ramirez MM, Ringer S, Simon WM, Weiner GM, Wyckoff M, Zaichkin J. Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S909-19. [PMID: 20956231 DOI: 10.1161/circulationaha.110.971119] [Citation(s) in RCA: 326] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Perlman JM, Wyllie J, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, Guinsburg R, Hazinski MF, Morley C, Richmond S, Simon WM, Singhal N, Szyld E, Tamura M, Velaphi S. Neonatal resuscitation: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1319-44. [PMID: 20956431 DOI: 10.1542/peds.2010-2972b] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, Gallagher J, Hazinski MF, Halamek LP, Kumar P, Little G, McGowan JE, Nightengale B, Ramirez MM, Ringer S, Simon WM, Weiner GM, Wyckoff M, Zaichkin J. Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2010; 126:e1400-13. [PMID: 20956432 DOI: 10.1542/peds.2010-2972e] [Citation(s) in RCA: 268] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Wyllie J, Perlman JM, Kattwinkel J, Atkins DL, Chameides L, Goldsmith JP, Guinsburg R, Hazinski MF, Morley C, Richmond S, Simon WM, Singhal N, Szyld E, Tamura M, Velaphi S. Part 11: Neonatal resuscitation. Resuscitation 2010; 81 Suppl 1:e260-87. [DOI: 10.1016/j.resuscitation.2010.08.029] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Dawson JA, Morley CJ. Monitoring oxygen saturation and heart rate in the early neonatal period. Semin Fetal Neonatal Med 2010; 15:203-7. [PMID: 20435536 DOI: 10.1016/j.siny.2010.03.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pulse oximetry is commonly used to assist clinicians in assessment and management of newly born infants in the delivery room (DR). In many DRs, pulse oximetry is now the standard of care for managing high risk infants, enabling immediate and dynamic assessment of oxygenation and heart rate. However, there is little evidence that using pulse oximetry in the DR improves short and long term outcomes. We review the current literature on using pulse oximetry to measure oxygen saturation and heart rate and how to apply current evidence to management in the DR.
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Affiliation(s)
- J A Dawson
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
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Dawson JA, Kamlin COF, Vento M, Wong C, Cole TJ, Donath SM, Davis PG, Morley CJ. Defining the reference range for oxygen saturation for infants after birth. Pediatrics 2010; 125:e1340-7. [PMID: 20439604 DOI: 10.1542/peds.2009-1510] [Citation(s) in RCA: 321] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal was to define reference ranges for pulse oxygen saturation (Spo(2)) values in the first 10 minutes after birth for infants who received no medical intervention in the delivery room. METHODS Infants were eligible if a member of the research team was available to record Spo(2) immediately after birth. Infants were excluded if they received supplemental oxygen or any type of assisted ventilation. Spo(2) was measured with a sensor applied to the right hand or wrist as soon as possible after birth; data were collected every 2 seconds. RESULTS We studied 468 infants and recorded 61650 Spo(2) data points. The infants had a mean + or - SD gestational age of 38 + or - 4 weeks and birth weight of 2970 + or - 918 g. For all 468 infants, the 3rd, 10th, 50th, 90th, and 97th percentile values at 1 minute were 29%, 39%, 66%, 87%, and 92%, respectively, those at 2 minutes were 34%, 46%, 73%, 91%, and 95%, and those at 5 minutes were 59%, 73%, 89%, 97%, and 98%. It took a median of 7.9 minutes (interquartile range: 5.0-10 minutes) to reach a Spo(2) value of >90%. Spo(2) values for preterm infants increased more slowly than those for term infants. We present percentile charts for all infants, term infants of > or = 37 weeks, preterm infants of 32 to 36 weeks, and extremely preterm infants of <32 weeks. CONCLUSION These data represent reference ranges for Spo(2) in the first 10 minutes after birth for preterm and term infants.
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Affiliation(s)
- Jennifer A Dawson
- Neonatal Services, The Royal Women's Hospital, Melbourne, Australia.
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Rüegger C, Bucher HU, Mieth RA. Pulse oximetry in the newborn: is the left hand pre- or post-ductal? BMC Pediatr 2010; 10:35. [PMID: 20492689 PMCID: PMC2879243 DOI: 10.1186/1471-2431-10-35] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Accepted: 05/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past few years, great efforts have been made to screen duct-dependent congenital heart diseases in the newborn. Arterial pulse oximetry screening (foot and/or right hand) has been put forth as the most useful strategy to prevent circulatory collapse. The left hand, however, has always been ignored, as it was unclear if the ductus arteriosus influences left-hand arterial perfusion. The objective of our study was to evaluate the impact of the arterial duct on neonatal pulse oximetry saturation (POS) on the left hand. METHODS In this observational study, arterial oxygen saturation on both hands and on one foot was measured within the first 4 hours of life. RESULTS Two hundred fifty-one newborns were studied: 53% males and 47% were delivered by caesarean section. The median gestational age was 38 4/7 weeks (90% CI, 32 6/7 - 41 2/7 weeks), the median birth weight was 3140 g (90% CI, 1655 - 4110 g) and the median age at recording was 60 minutes (90% CI, 15 - 210 minutes). The mean POS for the overall study population was 95.7% (90% CI, 90 - 100%) on the right hand, 95.7% (90% CI, 90 - 100%) on the left hand, and 94.9% (90% CI, 86 - 100%) on the foot. Four subgroups (preterm infants, babies with respiratory disorders, neonates delivered by caesarean section, and newborns < or =15 minutes of age) were formed and analysed separately. None of the subgroups showed a statistically significant difference between the right and left hands. Additionally, multivariate logistic regression did not identify any associated factors influencing the POS on the left hand. CONCLUSIONS With the exception of some children with complex or duct dependent congenital heart defects and some children with persistent pulmonary hypertension, POS on both hands can be considered equally pre-ductal.
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