RESUMO
UNLABELLED: Oxygen is a neonatal health hazard that should be avoided in clinical practice. In this review, an international team of neonatologists and nurses assessed oxygen saturation (SpO2 ) targeting in preterm infants and evaluated the potential weaknesses of randomised clinical trials. CONCLUSION: SpO2 of 85-89% can increase mortality and 91-95% can cause hyperoxia and ill effects. Neither of these ranges can be recommended, and wider intermediate targets, such as 87-94% or 88-94%, may be safer.
Assuntos
Hiperóxia/prevenção & controle , Hipóxia/prevenção & controle , Recém-Nascido Prematuro/sangue , Terapia Intensiva Neonatal/normas , Oxigênio/sangue , Humanos , Recém-Nascido , Monitorização Fisiológica , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
AIM: To identify whether pulse oximetry technology is associated with decreased retinopathy of prematurity (ROP) and laser treatment. METHODS: Inborn infants <1250 g who had eye exams were compared at two centres in three periods. In Period 1, SpO2 target was ≥93% and pulse oximetry technology was the same in both Centres. In Period 2, guidelines for SpO2 88-93% were implemented at both centres and Centre B changed to oximeters with signal extraction technology (SET(®)) while Centre A did not, but did so in Period 3. One ophthalmology department performed eye exams using international criteria. RESULTS: In 571 newborns <1250 g, birth weight and gestational age were similar in the different periods and centres. At Centre A, severe ROP and need for laser remained the same in Periods 1 and 2, decreasing in Period 3-6% and 3%, respectively. At Centre B, severe ROP decreased from 12% (Period 1) to 5% (Period 2) and need for laser decreased from 5% to 3%, remaining low in Period 3. CONCLUSION: In a large group of inborn infants <1250 g, a change in clinical practice in combination with pulse oximetry with Masimo SET, but not without it, led to significant reduction in severe ROP and need for laser therapy. Pulse oximetry selection is important in managing critically ill infants.
Assuntos
Oximetria , Retinopatia da Prematuridade/prevenção & controle , Feminino , Humanos , Recém-Nascido , Masculino , Oxigênio/análise , Estudos Prospectivos , Retinopatia da Prematuridade/diagnóstico , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: To evaluate whether mode of delivery is a predictor of poor short-term outcome at different birth weight categories in very low birth weight infants. METHODS: This study examined a cohort of infants weighing less than 1,251 g born at 2 perinatal centers from January 1, 2000, to December 31, 2003. Outborn infants or those with major anomalies were excluded from the study. Outcome variables included death, severe intraventricular hemorrhage, periventricular leukomalacia (PVL), and combined poor short-term outcomes (death, severe intraventricular hemorrhage, and PVL). RESULTS: Of the 397 infants who met enrollment criteria, 44% were born vaginally and 56% by cesarean delivery. The proportion of multiparous, breech presentation and prolonged rupture of membranes was significantly different between groups. For infants weighing less than 751 g, the risks of severe intraventricular hemorrhage (41% versus 22%; odds ratio [OR] 2.79, 95% confidence interval [CI] 1.08-7.72) and combined poor short-term outcome (67% versus 41%; OR 2.95, 95% CI 1.25-6.95) were significantly higher if delivered vaginally. Among survivors weighing less than 751 g, the risk of severe intraventricular hemorrhage was higher among those delivered vaginally (24% versus 9%; OR 8.18, 95% CI 1.58-42.20). In infants less 1,251 g who survived, vaginal delivery had a strong association with PVL (5% versus 1%; OR 11.53, 95% CI 1.66-125). CONCLUSION: In infants less than 1,251 g who survived to discharge, vaginal delivery is associated with higher risk for PVL. Furthermore, in infants less than 751 g, vaginal delivery is a predictor for severe intraventricular hemorrhage and combined poor short-term outcome. The negative impact of vaginal delivery mode decreases as birth weight category increases.
Assuntos
Parto Obstétrico/métodos , Mortalidade Infantil , Doenças do Prematuro/epidemiologia , Recém-Nascido de muito Baixo Peso , Hemorragia Cerebral/epidemiologia , Cesárea , Feminino , Humanos , Recém-Nascido , Leucomalácia Periventricular/etiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Gravidez , Fatores de RiscoRESUMO
OBJECTIVE: Our aim was to define the relationship of PaO(2) and pulse oxygen saturation values during routine clinical practice and to evaluate whether pulse oxygen saturation values between 85% and 93% were associated with PaO(2) levels of <40 mmHg. METHODS: Prospective comparison of PaO(2) and pulse oxygen saturation values in 7 NICUs at sea level in 2 countries was performed. The PaO(2) measurements were obtained from indwelling arterial catheters; simultaneous pulse oxygen saturation values were recorded if the pulse oxygen saturation values changed <1% before, during, and after the arterial gas sample was obtained. RESULTS: We evaluated 976 paired PaO(2)/pulse oxygen saturation values in 122 neonates. Of the 976 samples, 176 (18%) from infants breathing room air had a mean pulse oxygen saturation of 93.9 +/- 4.3% and a median of 95.5%. The analysis of 800 samples from infants breathing supplemental oxygen revealed that, when pulse oxygen saturation values were 85% to 93%, the mean PaO(2) was 56 +/- 14.7 mmHg and the median 54 mmHg. At this pulse oxygen saturation level, 86.8% of the samples had PaO(2) values of 40 to 80 mmHg, 8.6% had values of <40 mmHg, and 4.6% had values of >80 mmHg. When the pulse oxygen saturation values were >93%, the mean PaO(2) was 107.3 +/- 59.3 mmHg and the median 91 mmHg. At this pulse oxygen saturation level, 39.5% of the samples had PaO(2) values of 40 to 80 mmHg and 59.5% had values of >80 mmHg. CONCLUSIONS: High PaO(2) occurs very rarely in neonates breathing supplemental oxygen when their pulse oxygen saturation values are 85% to 93%. This pulse oxygen saturation range also is infrequently associated with low PaO(2) values. Pulse oxygen saturation values of >93% are frequently associated with PaO(2) values of >80 mmHg, which may be of risk for some newborns receiving supplemental oxygen.
Assuntos
Recém-Nascido/sangue , Unidades de Terapia Intensiva Neonatal , Oximetria , Oxigenoterapia , Humanos , Oxigênio , Oxiemoglobinas/análiseRESUMO
OBJECTIVE: To examine gender-specific differences in response to the O(2) saturation (SpO(2)) targets aimed at avoiding hyperoxia in very low birth weight infants (VLBW). METHODS: Analysis of a prospectively collected database of all infants =1250 g in two perinatal centres. A change was instituted in January 2003 with the objective of avoiding hyperoxia with target SpO(2) at 85-93% (period II). Prior to this, SpO(2) high alarms were set at 100% and low alarms at 92% (period I; from January 2000 to December 2002). RESULTS: Of the 497 infants that met enrolment criteria, 297 (60%) were born during period I and 140 (47%) of them were male. During period II, 200 infants were born and 101 (50%) were male. Analysis by gender showed that the rate of retinopathy of prematurity, bronchopulmonary dysplasia and length of stay is significantly better for female infants than males on period II compared to period I. Neither gender experienced increased short-term neurological morbidity in response to lower SpO(2) targets. CONCLUSIONS: There is a significant gender-specific difference favouring females in the beneficial effects produced by avoiding high SpO(2) and hyperoxia, with no difference in the distribution of any potential short-term detrimental effects.
Assuntos
Hiperóxia/prevenção & controle , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Oxigênio/administração & dosagem , Caracteres Sexuais , Displasia Broncopulmonar/epidemiologia , Feminino , Georgia/epidemiologia , Mortalidade Hospitalar , Humanos , Hiperóxia/complicações , Hiperóxia/fisiopatologia , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Masculino , Oxigênio/efeitos adversos , Retinopatia da Prematuridade/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Resultado do TratamentoRESUMO
UNLABELLED: Education in oxygenation and in how oxygen is given to newborns needs to increase. Treatment with oxygen should no longer be considered proverbial and customary, regardless of our 'past experience' or consensus recommendations in clinical guidelines, since oxygen may lead to acute or chronic health effects. CONCLUSION: Inappropriate oxygen use is a neonatal health hazard associated with aging, DNA damage and cancer, retinopathy of prematurity, injury to the developing brain, infection and others. Neonatal exposure to pure O2, even if brief, or to pulse oximetry >95% when breathing supplemental O2 must be avoided as much as possible.