Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model
<b>Background:</b> Currently, 21–30% supplemental oxygen is recommended during resuscitation of preterm neonates. Recent studies have shown that 58% of infants < 32 week gestation age are born with a heart rate (HR) < 100 bpm. Prolonged bradycardia with the inability to achieve a p...
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| Format: | Article |
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MDPI AG
2022-11-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/9/11/1750 |
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| author | Mausma Bawa Sylvia Gugino Justin Helman Lori Nielsen Nicole Bradley Srinivasan Mani Arun Prasath Clariss Blanco Andreina Mari Jayasree Nair Munmun Rawat Satyan Lakshminrusimha Praveen Chandrasekharan |
| author_facet | Mausma Bawa Sylvia Gugino Justin Helman Lori Nielsen Nicole Bradley Srinivasan Mani Arun Prasath Clariss Blanco Andreina Mari Jayasree Nair Munmun Rawat Satyan Lakshminrusimha Praveen Chandrasekharan |
| author_sort | Mausma Bawa |
| collection | DOAJ |
| description | <b>Background:</b> Currently, 21–30% supplemental oxygen is recommended during resuscitation of preterm neonates. Recent studies have shown that 58% of infants < 32 week gestation age are born with a heart rate (HR) < 100 bpm. Prolonged bradycardia with the inability to achieve a preductal saturation (SpO<sub>2</sub>) of 80% by 5 min is associated with mortality and morbidity in preterm infants. The optimal oxygen concentration that enables the achievement of a HR ≥ 100 bpm and SpO<sub>2</sub> of ≥80% by 5 min in preterm lambs is not known. <b>Methods:</b> Preterm ovine model (125–127 d, gestation equivalent to human neonates < 28 weeks) was instrumented, and asphyxia was induced by umbilical cord occlusion until bradycardia. Ventilation was initiated with 30% (OX30), 60% (OX60), and 100% (OX100) for the first 2 min and titrated proportionately to the difference from the recommended preductal SpO<sub>2</sub>. Our primary outcome was the incidence of the composite of HR ≥ 100 bpm and SpO<sub>2</sub> ≥ 80%, by 5 min. Secondary outcomes were to evaluate the time taken to achieve the primary outcome, gas exchange, pulmonary/systemic hemodynamics, and the oxidative injury. <b>Results:</b> Eighteen lambs (OX30-6, OX60-5. OX100-7) had an average HR < 91 bpm with a pH of <6.92 before resuscitation. Sixty seven percent achieved the primary outcome in OX100, 40% in OX60, and none in OX30. The time taken to achieve the primary outcome was significantly shorter with OX100 (6 ± 2 min) than with OX30 (10 ± 3 min) (* <i>p</i> = 0.04). The preductal SpO<sub>2</sub> was highest with OX100, while the peak pulmonary blood flow was lowest with OX30, with no difference in O<sub>2</sub> delivery to the brain or oxidative injury by 10 min. <b>Conclusions:</b> The use of 30%, 60%, and 100% supplemental O<sub>2</sub> in a bradycardic preterm ovine model did not demonstrate a significant difference in the composite primary outcome. The current recommendation to use 30% oxygen did not achieve a preductal SpO<sub>2</sub> of 80% by 5 min in any preterm lambs. Clinical studies to optimize supplemental O<sub>2</sub> in depressed preterm neonates not requiring chest compressions are warranted. |
| first_indexed | 2024-03-09T18:24:45Z |
| format | Article |
| id | doaj.art-b618eb8102484a0291b6e09f15a5c341 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
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| last_indexed | 2024-03-09T18:24:45Z |
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| series | Children |
| spelling | doaj.art-b618eb8102484a0291b6e09f15a5c3412023-11-24T08:00:26ZengMDPI AGChildren2227-90672022-11-01911175010.3390/children9111750Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm ModelMausma Bawa0Sylvia Gugino1Justin Helman2Lori Nielsen3Nicole Bradley4Srinivasan Mani5Arun Prasath6Clariss Blanco7Andreina Mari8Jayasree Nair9Munmun Rawat10Satyan Lakshminrusimha11Praveen Chandrasekharan12Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USADepartment of Pediatrics, Division of Neonatology, University of California Davis School of Medicine, Sacramento, CA 95817, USADepartment of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA<b>Background:</b> Currently, 21–30% supplemental oxygen is recommended during resuscitation of preterm neonates. Recent studies have shown that 58% of infants < 32 week gestation age are born with a heart rate (HR) < 100 bpm. Prolonged bradycardia with the inability to achieve a preductal saturation (SpO<sub>2</sub>) of 80% by 5 min is associated with mortality and morbidity in preterm infants. The optimal oxygen concentration that enables the achievement of a HR ≥ 100 bpm and SpO<sub>2</sub> of ≥80% by 5 min in preterm lambs is not known. <b>Methods:</b> Preterm ovine model (125–127 d, gestation equivalent to human neonates < 28 weeks) was instrumented, and asphyxia was induced by umbilical cord occlusion until bradycardia. Ventilation was initiated with 30% (OX30), 60% (OX60), and 100% (OX100) for the first 2 min and titrated proportionately to the difference from the recommended preductal SpO<sub>2</sub>. Our primary outcome was the incidence of the composite of HR ≥ 100 bpm and SpO<sub>2</sub> ≥ 80%, by 5 min. Secondary outcomes were to evaluate the time taken to achieve the primary outcome, gas exchange, pulmonary/systemic hemodynamics, and the oxidative injury. <b>Results:</b> Eighteen lambs (OX30-6, OX60-5. OX100-7) had an average HR < 91 bpm with a pH of <6.92 before resuscitation. Sixty seven percent achieved the primary outcome in OX100, 40% in OX60, and none in OX30. The time taken to achieve the primary outcome was significantly shorter with OX100 (6 ± 2 min) than with OX30 (10 ± 3 min) (* <i>p</i> = 0.04). The preductal SpO<sub>2</sub> was highest with OX100, while the peak pulmonary blood flow was lowest with OX30, with no difference in O<sub>2</sub> delivery to the brain or oxidative injury by 10 min. <b>Conclusions:</b> The use of 30%, 60%, and 100% supplemental O<sub>2</sub> in a bradycardic preterm ovine model did not demonstrate a significant difference in the composite primary outcome. The current recommendation to use 30% oxygen did not achieve a preductal SpO<sub>2</sub> of 80% by 5 min in any preterm lambs. Clinical studies to optimize supplemental O<sub>2</sub> in depressed preterm neonates not requiring chest compressions are warranted.https://www.mdpi.com/2227-9067/9/11/1750bradycardiasupplemental oxygensaturationsheart rate |
| spellingShingle | Mausma Bawa Sylvia Gugino Justin Helman Lori Nielsen Nicole Bradley Srinivasan Mani Arun Prasath Clariss Blanco Andreina Mari Jayasree Nair Munmun Rawat Satyan Lakshminrusimha Praveen Chandrasekharan Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model Children bradycardia supplemental oxygen saturations heart rate |
| title | Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model |
| title_full | Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model |
| title_fullStr | Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model |
| title_full_unstemmed | Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model |
| title_short | Initial Use of 100% but Not 60% or 30% Oxygen Achieved a Target Heart Rate of 100 bpm and Preductal Saturations of 80% Faster in a Bradycardic Preterm Model |
| title_sort | initial use of 100 but not 60 or 30 oxygen achieved a target heart rate of 100 bpm and preductal saturations of 80 faster in a bradycardic preterm model |
| topic | bradycardia supplemental oxygen saturations heart rate |
| url | https://www.mdpi.com/2227-9067/9/11/1750 |
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