Outcomes of oxygen saturation targeting during delivery room stabilisation of preterm infants.
Arch Dis Child Fetal Neonatal Ed
; 103(5): F446-F454, 2018 Sep.
Article
em En
| MEDLINE
| ID: mdl-28988158
ABSTRACT
OBJECTIVE:
To determine the association between SpO2 at 5 min and preterm infant outcomes.DESIGN:
Data from 768 infants <32 weeks gestation from 8 randomised controlled trials (RCTs) of lower (≤0.3) versus higher (≥0.6) initial inspiratory fractions of oxygen (FiO2) for resuscitation, were examined.SETTING:
Individual patient analysis of 8 RCTsINTERVENTIONS:
Lower (≤0.3) versus higher (≥0.6) oxygen resuscitation strategies targeted to specific predefined SpO2 before 10 min of age. PATIENTS Infants <32 weeks gestation. MAIN OUTCOMEMEASURES:
Relationship between SpO2 at 5 min, death and intraventricular haemorrhage (IVH) >grade 3.RESULTS:
5 min SpO2 data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO2 study targets and 323 (46%) did not reach SpO280%. Pooled data showed decreased likelihood of reaching SpO280% if resuscitation was initiated with FiO2 <0.3 (OR 2.63, 95% CI 1.21 to 5.74, p<0.05). SpO2 <80% was associated with lower heart rates (mean difference -8.37, 95% CI -15.73 to -1.01, *p<0.05) and after accounting for confounders, with IVH (OR 2.04, 95% CI 1.01 to 4.11, p<0.05). Bradycardia (heart rate <100 bpm) at 5 min increased risk of death (OR 4.57, 95% CI 1.62 to 13.98, p<0.05). Taking into account confounders including gestation, birth weight and 5 min bradycardia, risk of death was significantly increased with time taken to reach SpO280%.CONCLUSION:
Not reaching SpO280% at 5 min is associated with adverse outcomes, including IVH. Whether this is because of infant illness or the amount of oxygen that is administered during stabilisation is uncertain and needs to be examined in randomised trials.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Oxigenoterapia
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Ressuscitação
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Bradicardia
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Hemorragia Cerebral Intraventricular
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Doenças do Prematuro
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article