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Is 21% oxygen best for newborn resuscitation? – Author's reply

2011; Elsevier BV; Volume: 377; Issue: 9772 Linguagem: Inglês

10.1016/s0140-6736(11)60462-5

1474-547X

Ola Didrik Saugstad,

Cardiac Arrest and Resuscitation

Bing Hou and colleagues raise some timely questions about the use of oxygen or air for newborn resuscitation. After my Comment was accepted, the International Liaison Committee on Resuscitation stated in their 2010 guidelines for newborn resuscitation that “it is best to begin with air rather than 100% oxygen”.1Perlman JM Wyllie J Kattwinkel J et al.for the Neonatal Resuscitation Chapter CollaboratorsPart 11: neonatal resuscitation. 2010 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.Circulation. 2010; 122: S516-S538Crossref PubMed Scopus (531) Google Scholar In our first clinical studies with air versus 100% oxygen,2Saugstad OD Rootwelt T Aalen O Resuscitation of asphyxiated newborn infants with room air or oxygen: an international controlled trial: the Resair 2 study.Pediatrics. 1998; 102: e1Crossref PubMed Scopus (365) Google Scholar we showed that it is possible to resuscitate with air, having oxygen as a backup and switching to oxygen after 90 s in the absence of a satisfactory response to air. Oxygenation depends, however, largely on lung surface area so it is not appropriate to start giving oxygen until appropriate attempts have been made to aerate the lung. Only in a few cases should oxygen be given. There are no solid data to guide us as to which oxygen concentrations should be used in each case. I and many others have for years recommended that oxygen supplementation should be guided by pulse oximeters, provided a pulse oximeter with proper technology is available. Reference values for oxygen saturations the first minutes after birth have been published.3Dawson JA Kamlin CO Vento M et al.Defining the reference range for oxygen saturation for infants after birth.Pediatrics. 2010; 125: e1340-e1347Crossref PubMed Scopus (358) Google Scholar Some have suggested using these references as a guide.4Vento M Saugstad OD Oxygen supplementation in the delivery room: updated information.J Pediatr. 2011; 158: e5-e7Summary Full Text Full Text PDF PubMed Scopus (27) Google Scholar Until more data are available, we should provide 100% oxygen if there is a need for chest compressions or drugs, and subsequently wean down oxygen as quickly as possible. What about high altitude? Gonzales and Salirrosas5Gonzales GF Salirrosas A Arterial oxygen saturation in healthy newborns delivered at term in Cerro de Pasco (4340 m) and Lima (150 m).Reprod Biol Endocrinol. 2005; 3: 46Crossref PubMed Scopus (45) Google Scholar showed that oxygen saturation is significantly higher in infants born at sea level (Lima, 150 m above sea level) than in infants born at a higher altitude (Cerro de Pasco, 4340 m) from 1 min to 24 h after birth. Until specific data are available from high-altitude areas, I recommend starting resuscitation with air, being prepared to add oxygen in selected cases. In most cases the pulmonary arterial pressure decreases satisfactorily with air resuscitation. To my knowledge there are no data to show that mixing nitric oxide with air during resuscitation of neonates is beneficial. This question should be addressed in an appropriately designed randomised controlled trial. Until data are available to show a potential short-term and long-term benefit of adding nitric oxide to the resuscitation gas, such a practice is in my opinion not recommendable. I declare that I have no conflicts of interest. Is 21% oxygen best for newborn resuscitation?Pure oxygen had long been used to resuscitate neonates, but this practice has been critically questioned during the past three decades. In a Comment (Dec 11, p 1970),1 Ola Saugstad highlights that use of 100% oxygen for newborn resuscitation might be highly dangerous and advocates that pure oxygen should give way to ambient air. Undoubtedly, this call is resounding and timely. However, several points remain to be adequately addressed. Full-Text PDF