Room-air resuscitation causes less damage to heart and kidney than 100% oxygen.
BACKGROUND
Pure oxygen causes more oxidative stress than room air in resuscitation of asphyctic neonates, and consequently could be associated with increased tissue damage.


OBJECTIVE
To compare damage caused to heart and kidneys on reoxygenation in severely asphyctic term neonates resuscitated with room air (RAR) or 100% oxygen (OxR). Nonasphyctic term newborn infants served as a control group.


METHODS
This is a prospective randomized clinical trial masked for the gas mixture. Reduced glutathione (GSH), oxidized glutathione (GSSG), and superoxide dismutase (SOD) activity were measured to assess oxidative stress. Plasma cardiac troponin T (cTnT) and urinary N-acetyl-glucosaminidase (NAG) assessed cardiac and renal damage, respectively. Daily determinations of NAG for a 2-wk period were performed to monitor postasphyctic renal damage.


RESULTS
Both asphyctic groups showed oxidative stress when compared with the control group as evidenced by diminished GSH/GSSG ratios, adaptive increases in SOD activity, and higher values of NAG and cTnT (markers of tissue damage). However, the OxR group showed significantly higher values of NAG and cTnT, lower GSH/GSSG ratios, and higher SOD activity than the RAR group. Moreover, NAG values persisted in being higher than normal in the OxR group for 2 wk after birth, whereas NAG in the RAR group dropped to normal within the first week. A linear correlation between cTnT or NAG and GSSG was found.


CONCLUSIONS
The use of room air on resuscitation causes less oxidative stress and damage to heart and kidney than pure oxygen.
Vento
Máximo
M
Neonatal Research Unit, Servicio de Neonatología, Hospital Universitario Materno-Infantil La Fe, Avenida de Campanar 21, 46009 Valencia, Spain. maximo.vento@uv.es
Sastre
Juan
J
Asensi
Miguel A
MA
Viña
José
J
D000118:Acetylglucosaminidase / Q000652:urine; D000388:Air; D001238:Asphyxia Neonatorum / Q000097:blood / Q000628:therapy* / Q000652:urine; D015415:Biomarkers / Q000097:blood / Q000652:urine; D009202:Cardiomyopathies / Q000517:prevention & control*; D002851:Chromatography, High Pressure Liquid; D003404:Creatinine / Q000097:blood / Q000652:urine; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000517:prevention & control*; D018384:Oxidative Stress / Q000502:physiology; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012138:Respiratory Therapy / Q000379:methods*; D012151:Resuscitation / Q000379:methods*; D012720:Severity of Illness Index; D013482:Superoxide Dismutase / Q000097:blood; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D020107:Troponin T; D003404:Creatinine; D013482:Superoxide Dismutase; D000118:Acetylglucosaminidase