title: Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration.
abstract: BACKGROUND
  The Neonatal Resuscitation Program (NRP) recommends upper and lower limits of preductal saturations (SpO2) extrapolated from studies in infants resuscitated in room air. These limits have not been validated in asphyxia and lung disease.
  
  
  METHODS
  Seven control term lambs delivered by cesarean section were ventilated with 21% O2. Thirty lambs with asphyxia with meconium aspiration were randomly assigned to resuscitation with 21% O2 (n = 6), 100% O2 (n = 6), or initiation with 21% O2 followed by variable FIO2 to maintain NRP target SpO2 ranges (n = 18). Hemodynamic and ventilation parameters were recorded for 15 min.
  
  
  RESULTS
  Control lambs maintained preductal SpO2 near the lower limit of NRP target range. Asphyxiated lambs had low SpO2 (38 ± 2%), low arterial pH (6.99 ± 0.01), and high PaCO2 (96 ± 7 mm Hg) at birth. Resuscitation with 21% O2 resulted in SpO2 values below the target range with low pulmonary blood flow (Qp) compared to variable FIO2 group. The increase in PaO2 and Qp with variable FIO2 resuscitation was similar to control lambs.
  
  
  CONCLUSIONS
  Maintaining SpO2 as recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and higher Qp in asphyxiated lambs with lung disease. Our findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Munmun
authors.initials: M
authors.lastname: Rawat
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Praveen K
authors.initials: PK
authors.lastname: Chandrasekharan
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.|Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Swartz
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Bobby
authors.initials: B
authors.lastname: Mathew
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Nair
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.|Department of Physiology and Biophysics, University at Buffalo, Buffalo, New York.
authors.forename: Sylvia F
authors.initials: SF
authors.lastname: Gugino
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Carmon
authors.initials: C
authors.lastname: Koenigsknecht
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Payam
authors.initials: P
authors.lastname: Vali
authors.affiliation: Department of Pediatrics, University at Buffalo, Buffalo, New York.
authors.forename: Satyan
authors.initials: S
authors.lastname: Lakshminrusimha
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001237:Asphyxia / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D008471:Meconium Aspiration Syndrome / Q000150:complications* / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D012151:Resuscitation
chemical_list: D010100:Oxygen