Recent discussions
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ILCOR Staff
I think that these recommendations are a good start to resuscitation guidelines for premature babies. However, ELBW 23 weekers should not be included with AGA 34 weekers in an all-encompassing statement. This is too wide of an age range, and the ELBW infants are more susceptible to complications from resuscitation. We have instituted a small-baby protocol for infants less than or equal to 30 weeks to prevent IVH in those infants, which involves more interventions than just oxygen titration. I would like to see research more specific to smaller age ranges in the premature infant population. I agree that starting with low O2 concentrations (30-40%) is better and increasing concentration as needed based on O2 saturations and age of life. -
ILCOR Staff
Thank you for the review. I agree with the recommendations. I especially like the statement: "In still suggesting to start with low oxygen concentrations, we place value on avoiding exposure of preterm babies to additional oxygen without proven benefit for critical or important outcomes We are currently beginning with lower Oxygen for all deliveries and following oxygen saturation’s per NRP recommendations. If an infant requires full resuscitation, we will increase oxygen to 100%. -
ILCOR Staff
I agree with starting at a lower concentration (30%) and adjusting upward as needed per pulse ox or ABG. We have had excellent results with keeping our FIO2 low . Also with giving surfactant and extubating quickly we have been able to keep those levels low. -
ILCOR Staff
No unfortunately there are no data available to guide titration. This is an area which needs more research. Part of the difficulty is that good trials which inform this question were performed at a time when use of saturation monitoring was less prevalent. Similarly there is no data to compare other starting concentrations of oxygen. -
ILCOR Staff
I agree with the recommendations of starting at room air, 21%. -
ILCOR Staff
I agree -
ILCOR Staff
Thank you for this excellent summary. Pending further RCTs dedicated to the administration of oxygen in ELGAN, we report the highest neurological and / or death risk reported by some studies (Rabi 2015; Oei 2016) on this fragile population resuscitated in the air or with low concentrations of oxygen. I think the most balanced choice is to start with 30% and continue on the basis of the levels of SaO2 in relation to the minutes of life. -
ILCOR Staff
I agree with the findings of the study. I find very few term babies need more than 21% oxygen. -
Chris McKinlay
Thanks to the authors of this statement. It would be helpful to mention if any studies used pulse oximetry and saturation targeting, and how many babies who were commenced in air required oxygen. I think the recommendation should say something like "consider subsequent supplemental oxygen, titrated using pulse oximetry, if the baby's condition does not improve following initial resuscitation measures." -
ILCOR Staff
Thank you for this excellent summary. Please consider creating from these recommendation, specific charts for birthing units that detail the oxygen saturation goals, according to gestation and minutes of life. These specifics are very useful to clinicians who may have limited education or excess care burdens, such as the night shift. Providers will 'do' if they 'know', and one wall chart to follow with room air progression to higher concentrations based on the oxygen saturation measures (oximetry) would be a clinical help. Ideally oximetry should be available, but this is not the case in many very busy obstetric and neonatal units in the global south. Clinical perfusion, including capillary refill and basics might be addressed please for those of us who are teaching in low-resource settings. We all, including me, benefit from simple, effective graphics right on the wall beside the resuscitation table when there is a stressful resuscitation or a sick baby, with limited help for these emergencies. Thank you for this comprehensive work.