Initiating delivery room stabilization/resuscitation in very low birth weight (VLBW) infants with an FiO(2) less than 100% is feasible.
BACKGROUND
Oxygen exposure during delivery room (DR) resuscitation, even when brief, is potentially toxic. A practice plan (PP) was introduced for very low birth weight (VLBW) infants < or = 1500 g as follows: initial FiO(2) from 0.21 to 1.0 using blenders, oxygen guided by oximetry to maintain saturation between 85% to 95% from birth.


OBJECTIVE
To determine whether the initiating FiO(2) could be safely lowered, and by doing so whether the number of infants with a PaO(2) >80 mm Hg could be minimized on admission, as well as lowering oxygen requirement at 24 h.


METHODS
In all, 53 infants admitted between June 2006 and June 2007 were evaluated and compared with 47 infants from 2004 managed with 100 % oxygen (historical comparison group (HC)).


RESULTS
Stabilization/Resuscitation included intubation (n=28) and continuous positive airway pressure (CPAP) (n=25); no cardiopulmonary resuscitation (CPR). The heart rate increased rapidly in all cases. The initiating FiO(2) decreased from 0.42 to 0.28 over 12 months (P=0.00005); 14 (26%) were resuscitated with room air. Correspondingly, the pH increased from 7.24 to 7.30 (P=0.002) and PCO(2) decreased from 53 to 41 (P=0.001). A comparison of infants during the PP with the HC revealed that 36/53 versus 21/47 had an initial PaO(2) <80 mm Hg (P=0.02); the median PaO(2), that is, 64 versus 86 and saturation, that is, 95% versus 99% on admission were significantly lower. The median FiO(2) at 24 h was 0.25 versus 0.40.


CONCLUSIONS
DR resuscitation of VLBW infants can be initiated with less oxygen even with room air without concomitant overt morbidity. This change was associated with more infants with an initial PaO(2) <80 mm Hg and lower saturation values on admission as well as a lower FiO(2) requirement at 24 h.
Stola
A
A
Department of Pediatrics, Division of Newborn Medicine, Weill Cornell Medical College, New York, NY 10065, USA.
Schulman
J
J
Perlman
J
J
D016022:Case-Control Studies; D045422:Continuous Positive Airway Pressure; D019091:Critical Pathways; D003696:Delivery Rooms; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007442:Intubation, Intratracheal; D010092:Oximetry; D010102:Oxygen Inhalation Therapy / Q000379:methods*