Original ArticlesImpact of the Neonatal Resuscitation Program–Recommended Low Oxygen Strategy on Outcomes of Infants Born Preterm
Section snippets
Methods
A retrospective cohort study was conducted to examine neonates born preterm at ≤28 weeks' gestational age (GA) between August 2009 and April 2012 at Parkland Hospital, Dallas, Texas. The study was approved by University of Texas Southwestern Medical Center institutional review board.
At Parkland Hospital before March 2011, in compliance with the 2006 NRP guidelines,22 neonates born preterm were resuscitated in the delivery room with a high oxygen strategy (HOX) where stabilization was initiated
Results
During the study period, 255 neonates were born at 23-28 weeks' GA (Figure). After we excluded neonates who received only comfort care at the request of their family and those who were enrolled in a delivery room randomized control trial of different oxygen strategies,8 199 neonates were included in the study. Of these, 89 were resuscitated with LOX and 110 were resuscitated with HOX. After we accounted for mortality before neurodevelopmental assessment and loss to follow-up, 87% of the study
Discussion
This study demonstrates that neonates born preterm resuscitated with the NRP-recommended LOX strategy were exposed to lower oxygen load in the delivery room, had fewer days on oxygen in the NICU, and had a lower incidence of BPD, even after we adjusted for confounding variables. Infants resuscitated with LOX also had no increase in mortality and had greater Bayley III motor composite scores at 2-year follow-up.
It is possible that the reduced oxygen load in the delivery room resulted in a lower
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2024, Critical Care Nursing Clinics of North AmericaQuality improvement for neonatal resuscitation and delivery room care
2022, Seminars in PerinatologyOptimizing oxygen therapy for preterm infants at birth: Are we there yet?
2020, Seminars in Fetal and Neonatal MedicineCitation Excerpt :In this meta-analysis, 1007 preterm newborns were included from 10 Randomized control trials and 2 long-term follow-ups of included RCTs [7,8,39,45–54]. In addition, four observational studies were also included [40,55–57]. A summary of the studies is included in Tables 1–3.
2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations
2019, ResuscitationCitation Excerpt :All observational studies used 100% as the high initial oxygen concentration. A majority of RCTs (8 of 10)171–178 and all of the observational cohort studies180–183 used Spo2 targeting as a cointervention. All results are presented as RR with 95% CI and absolute difference with 95% CI.
Targeting Oxygen in Term and Preterm Infants Starting at Birth
2019, Clinics in PerinatologyCitation Excerpt :Oxygen was titrated thereafter according to evolving Spo2 and heart rate to meet Neonatal Resuscitation Program–recommended transitional target saturations. No difference in mortality was found, but neonates in the low-oxygen group had higher motor composite scores on Bayley III scale (91[85,97] vs 88 [76, 94]; P<.01).67 However, in the Torpido trial,65 infants less than 28 weeks’ gestation randomized to an iFio2 of 0.21 had a higher mortality before hospital discharge (22%) compared with infants given 100% oxygen (6%) (RR, 3.9; 95% CI, 1.1–13.4; P = .01).
Supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health 1K23HD083511-01A1 (to V.K.). The authors declare no conflicts of interest.