Preterm resuscitation with low oxygen causes less oxidative stress, inflammation, and chronic lung disease.
OBJECTIVE
The goal was to reduce adverse pulmonary adverse outcomes, oxidative stress, and inflammation in neonates of 24 to 28 weeks of gestation initially resuscitated with fractions of inspired oxygen of 30% or 90%.


METHODS
Randomized assignment to receive 30% (N = 37) or 90% (N = 41) oxygen was performed. Targeted oxygen saturation values were 75% at 5 minutes and 85% at 10 minutes. Blood oxidized glutathione (GSSG)/reduced glutathione ratio and urinary o-tyrosine, 8-oxo-dihydroxyguanosine, and isoprostane levels, isofuran elimination, and plasma interleukin 8 and tumor necrosis factor alpha levels were determined.


RESULTS
The low-oxygen group needed fewer days of oxygen supplementation (6 vs 22 days; P < .01) and fewer days of mechanical ventilation (13 vs 27 days; P < .01) and had a lower incidence of bronchopulmonary dysplasia at discharge (15.4% vs 31.7%; P < .05). GSSG/reduced glutathione x 100 ratios at day 1 and 3 were significantly higher in the high-oxygen group (day 1: high-oxygen group: 13.36 +/- 5.25; low-oxygen group: 8.46 +/- 3.87; P < .01; day 3: high-oxygen group: 8.87 +/- 4.40; low-oxygen group: 6.97 +/- 3.11; P < .05). Urinary markers of oxidative stress were increased significantly in the high-oxygen group, compared with the low-oxygen group, in the first week after birth. GSSG levels on day 3 and urinary isofuran, o-tyrosine, and 8-hydroxy-2'-deoxyguanosine levels on day 7 were correlated significantly with development of chronic lung disease.


CONCLUSIONS
Resuscitation of preterm neonates with 30% oxygen causes less oxidative stress, inflammation, need for oxygen, and risk of bronchopulmonary dysplasia.
Vento
Maximo
M
Department of Pediatrics, Neonatal Research Unit, Division of Neonatology, University Hospital La Fe, Valencia, Spain. maximo.vento@uv.es
Moro
Manuel
M
Escrig
Raquel
R
Arruza
Luis
L
Villar
Gema
G
Izquierdo
Isabel
I
Roberts
L Jackson
LJ
Arduini
Alessandro
A
Escobar
Justo Javier
JJ
Sastre
Juan
J
Asensi
Miguel A
MA
D001997:Bronchopulmonary Dysplasia / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000517:prevention & control*; D007249:Inflammation / Q000517:prevention & control*; D008297:Male; D018384:Oxidative Stress; D010100:Oxygen / Q000008:administration & dosage*; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*
D010100:Oxygen