The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial
Background: Infants are currently stabilized at birth with initial low FiO2 which increases the risk of hypoxia and suppression of breathing in the first minutes after birth. We hypothesized that initiating stabilization at birth with a high O2 concentration, followed by titration, would improve bre...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-12-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2019.00504/full |
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| author | Janneke Dekker Tessa Martherus Enrico Lopriore Martin Giera Erin V. McGillick Erin V. McGillick Jeroen Hutten Ruud W. van Leuteren Anton H. van Kaam Stuart B. Hooper Stuart B. Hooper Arjan B. te Pas |
| author_facet | Janneke Dekker Tessa Martherus Enrico Lopriore Martin Giera Erin V. McGillick Erin V. McGillick Jeroen Hutten Ruud W. van Leuteren Anton H. van Kaam Stuart B. Hooper Stuart B. Hooper Arjan B. te Pas |
| author_sort | Janneke Dekker |
| collection | DOAJ |
| description | Background: Infants are currently stabilized at birth with initial low FiO2 which increases the risk of hypoxia and suppression of breathing in the first minutes after birth. We hypothesized that initiating stabilization at birth with a high O2 concentration, followed by titration, would improve breathing effort when compared to a low O2 concentration, followed by titration.Methods: In a bi-center randomized controlled trial, infants <30 weeks gestation were stabilized at birth with an initial O2 concentration of 30 or 100%, followed by oxygen titration. Primary outcome was minute volume of spontaneous breathing. We also assessed tidal volumes, mean inspiratory flow rate (MIFR) and respiratory rate with a respiratory function monitor in the first 5 min after birth, and evaluated the duration of mask ventilation in the first 10 min after birth. Pulse oximetry was used to measure heart rate and SpO2 values in the first 10 min. Hypoxemia was defined as SpO2 < 25th percentile and hyperoxemia as SpO2 >95%. 8-iso-prostaglandin F2α (8iPGF2α) was measured to assess oxidative stress in cord blood and 1 and 24 h after birth.Results: Fifty-two infants were randomized and recordings were obtained in 44 infants (100% O2-group: n = 20, 30% O2-group: n = 24). Minute volumes were significantly higher in the 100% O2-group (146.34 ± 112.68 mL/kg/min) compared to the 30% O2-group (74.43 ± 52.19 mL/kg/min), p = 0.014. Tidal volumes and MIFR were significantly higher in the 100% O2-group, while the duration of mask ventilation given was significantly shorter. Oxygenation in the first 5 min after birth was significantly higher in infants in the 100% O2-group [85 (64–93)%] compared to the 30% O2-group [58 (46–67)%], p < 0.001. The duration of hypoxemia was significantly shorter in the 100% O2-group, while the duration of hyperoxemia was not different between groups. There was no difference in oxidative stress marker 8iPGF2α between the groups.Conclusion: Initiating stabilization of preterm infants at birth with 100% O2 led to higher breathing effort, improved oxygenation, and a shorter duration of mask ventilation as compared to 30% O2, without increasing the risk for hyperoxia or oxidative stress.Clinical Trial Registration: This study was registered in www.trialregister.nl, with registration number NTR6878. |
| first_indexed | 2024-12-10T23:56:36Z |
| format | Article |
| id | doaj.art-f436abf153254fe897b24fd2c1275e53 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-12-10T23:56:36Z |
| publishDate | 2019-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-f436abf153254fe897b24fd2c1275e532022-12-22T01:28:35ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602019-12-01710.3389/fped.2019.00504494441The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled TrialJanneke Dekker0Tessa Martherus1Enrico Lopriore2Martin Giera3Erin V. McGillick4Erin V. McGillick5Jeroen Hutten6Ruud W. van Leuteren7Anton H. van Kaam8Stuart B. Hooper9Stuart B. Hooper10Arjan B. te Pas11Department of Neonatology, Leiden University Medical Center, Leiden, NetherlandsDepartment of Neonatology, Leiden University Medical Center, Leiden, NetherlandsDepartment of Neonatology, Leiden University Medical Center, Leiden, NetherlandsCenter Proteomics Metabolomics, Leiden University Medical Center, Leiden, NetherlandsThe Ritchie Centre, Hudson Institute for Medical Research, Melbourne, VIC, AustraliaDepartment of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, AustraliaDepartment of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsDepartment of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, NetherlandsThe Ritchie Centre, Hudson Institute for Medical Research, Melbourne, VIC, AustraliaDepartment of Obstetrics and Gynaecology, Monash University, Melbourne, VIC, AustraliaDepartment of Neonatology, Leiden University Medical Center, Leiden, NetherlandsBackground: Infants are currently stabilized at birth with initial low FiO2 which increases the risk of hypoxia and suppression of breathing in the first minutes after birth. We hypothesized that initiating stabilization at birth with a high O2 concentration, followed by titration, would improve breathing effort when compared to a low O2 concentration, followed by titration.Methods: In a bi-center randomized controlled trial, infants <30 weeks gestation were stabilized at birth with an initial O2 concentration of 30 or 100%, followed by oxygen titration. Primary outcome was minute volume of spontaneous breathing. We also assessed tidal volumes, mean inspiratory flow rate (MIFR) and respiratory rate with a respiratory function monitor in the first 5 min after birth, and evaluated the duration of mask ventilation in the first 10 min after birth. Pulse oximetry was used to measure heart rate and SpO2 values in the first 10 min. Hypoxemia was defined as SpO2 < 25th percentile and hyperoxemia as SpO2 >95%. 8-iso-prostaglandin F2α (8iPGF2α) was measured to assess oxidative stress in cord blood and 1 and 24 h after birth.Results: Fifty-two infants were randomized and recordings were obtained in 44 infants (100% O2-group: n = 20, 30% O2-group: n = 24). Minute volumes were significantly higher in the 100% O2-group (146.34 ± 112.68 mL/kg/min) compared to the 30% O2-group (74.43 ± 52.19 mL/kg/min), p = 0.014. Tidal volumes and MIFR were significantly higher in the 100% O2-group, while the duration of mask ventilation given was significantly shorter. Oxygenation in the first 5 min after birth was significantly higher in infants in the 100% O2-group [85 (64–93)%] compared to the 30% O2-group [58 (46–67)%], p < 0.001. The duration of hypoxemia was significantly shorter in the 100% O2-group, while the duration of hyperoxemia was not different between groups. There was no difference in oxidative stress marker 8iPGF2α between the groups.Conclusion: Initiating stabilization of preterm infants at birth with 100% O2 led to higher breathing effort, improved oxygenation, and a shorter duration of mask ventilation as compared to 30% O2, without increasing the risk for hyperoxia or oxidative stress.Clinical Trial Registration: This study was registered in www.trialregister.nl, with registration number NTR6878.https://www.frontiersin.org/article/10.3389/fped.2019.00504/fullpreterm infantrespiratory effortbreathingoxygenresuscitation |
| spellingShingle | Janneke Dekker Tessa Martherus Enrico Lopriore Martin Giera Erin V. McGillick Erin V. McGillick Jeroen Hutten Ruud W. van Leuteren Anton H. van Kaam Stuart B. Hooper Stuart B. Hooper Arjan B. te Pas The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial Frontiers in Pediatrics preterm infant respiratory effort breathing oxygen resuscitation |
| title | The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial |
| title_full | The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial |
| title_fullStr | The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial |
| title_full_unstemmed | The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial |
| title_short | The Effect of Initial High vs. Low FiO2 on Breathing Effort in Preterm Infants at Birth: A Randomized Controlled Trial |
| title_sort | effect of initial high vs low fio2 on breathing effort in preterm infants at birth a randomized controlled trial |
| topic | preterm infant respiratory effort breathing oxygen resuscitation |
| url | https://www.frontiersin.org/article/10.3389/fped.2019.00504/full |
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