Recent discussions
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ILCOR Staff
Thanks to the authors of this well-written statement. 1) Presumably the format for presentation of results has been mandated, but strictly speaking the evidence is "inconclusive"; evidence that shows "no benefit or harm" is something different. 2) I agree that in the absence of evidence it is not possible to say if starting in air is better or worse than 30-40% but I am sympathetic to the concerns expressed above about use of air. I wonder if the second paragraph of the justification could be expanded to say something like "until further evidence is available, we recommend that individual units decide on a starting concentration between 21-30% based on local practice considerations and ongoing audit of care". 3) Second point in knowledge gaps: "Further evidence is needed from randomized studies about long term NDI outcomes". -
ILCOR Staff
Congrats to authors on the comprehensive job done, however the jury is still out. We are still in need of more compelling evidence to rescue ELGANs in 21% FiO2. While the partial pressure of oxygen in utero is quite low, and therefore brain is likely not significantly damaged from brief episode of hypoxia at birth, it has not yet been proven by any of the studies sited here. I agree that without compelling evidence some O2 (30-40%) would be best in this vulnerable group, at least until better long-term neurodevelopmental follow-up can be evaluated. First, do no harm. -
ILCOR Staff
I certainly agree with recommendation for starting with Room Air oxygen for Term Neonates. As a Neonatologist have following this recommendation for term newborns since NRP 5th edition was released, and now we have definite science to show that is good practice to start resuscitation in term newborn with room air. Oxygen free radicals can cause much more harm, than transient hypoxia. -
ILCOR Staff
I agree with the recommendations. -
ILCOR Staff
I agree with your well researched conclusions. Locally we have been using 40% start and reduced to 30% 2 years ago. Your recommended range of 21% to 30% could be interpreted as 21% or 30% . I would favour the latter as this seems to offer good transition in practice. One practical problem with starting in air is that people 'forget' to turn it up in a crisis, or turn up in very small increments, once they get distracted by intubation, CPR etc, whereas when the saturations are too high people usually notice and turn it down. So would pragmatically agree with the principle Start lower rather than start higher, but might still recommend 30% rather than air. I agree with others that once starting CPR should consider 100% oxygen. -
ILCOR Staff
Agree with starting in Air in term and near term infants Problem is it gets turned up slowly or not at all.... I would suggest if starting CPR t turn I up to 100% and then titrate down if Sats >95% -
ILCOR Staff
I agree with findings of study. -
ILCOR Staff
In our low clinically resourced setting with 100 deliveries per day - we use room air to start resus - if compressions we use oxygen concentrator. If the power is off we have no oxygen concentrator - Just bag and mask on room air. Most babies respond well initially. Very sick babies - Moderate to severe birth asphyxia we only have low oxygen available. We practice delayed cord clamping and start resus at the mother on her chest Immediately including when starting compressions - we do not wait to clamp & cut cord - the baby requires the vital extra few minutes of blood to help in the ongoing care and neonatal outcomes both in the initial stages of resus and beyond. Assists with thermoregulation as well because if power is off we have no heater. -
ILCOR Staff
Very well written and comprehensive review - BRAVO authors We start with oxygen through an oxygen concentrator (Sub Sahara Africa) in many unwell babies born early - with 100 deliveries per day we have many resus/day. Debasis Kanjilal 2019.01.18 10:19:38 (modified: 2019.01.18 17:57:45) Makes some good points especially valuable in our clinical setting. Some research in this space is needed. We have some very good outcomes despite lack of resources and medication like surfactant. Conversely poor outcomes. If we are giving compressions (often) we transfer when stable to Unit where we have CPAP and oxygen low flow. Its compelling research to start low and nitrate up - and guidelines of NRP; if full resus 100% oxygen -
ILCOR Staff
I agree