Recent discussions
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ILCOR Staff
I congratulate authors for their well done job. However, I want to signal that Rabi et al. "observed a higher risk of severe neurologic injury or death among preterm infants of ≤ 27 weeks gestation following a change in practice to initiating resuscitation with either room air or an intermediate oxygen concentration." (Resuscitation, 2015). Similarly, Oei et al. found that "Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation", although "This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably.". Therefore, it might be better to start resuscitation with some oxygen (FiO2 30-40%) adjusting it on the basis of SpO2. -
ILCOR Staff
I agree -
ILCOR Staff
I agree the current recommendation. -
ILCOR Staff
Iniciar sempre com FiO2 de 21% -
ILCOR Staff
I agree with the recommendations to start in 21% oxygen as most infants will transition with good airway management, may be there could be some suggested guidance as to when you would consider increasing the oxygen concentration.... e.g. at time of starting chest compressions? -
John Mouw
I agree with the recommendations of starting at room air, 21%. -
ILCOR Staff
Starting with 21% O2 is reasonably the best approach, but I usually increase O2 concentration if the baby does not respond with an increase in heart rate in 15-20 seconds. Most babies react well rapidly and I do not believe that few seconds of O2 at higher-than-normal concentration can be harmful for their future. The problem is different when infants DO NOT respond rapidly and are moderately to severely asphyxiated: should we increase O2 to...what? In this case, reperfusion injury should always be kept in mind, as a consequence of too much O2 -
ILCOR Staff
I agree with the recommendations. All infant resuscitations should start at 21% and titrate up as required. -
ILCOR Staff
I agree with the recommendation -
ILCOR Staff
I agree that beginning with 21% O2 is appropriate for the newborn born at 35+ weeks gestation. The goal is to support initiation of spontaneous respiration and closure of the ductus arteriosus. The current NRP guidelines are very clear that when 21% is not effective, one can transition to a higher percentage of O2. It would be useful to provide information on the normal range of O2 saturation of the well fetus to highlight that this is a period of transition, best supported with an intact cord (https://www.nature.com/articles/jp2016151 and https://www.frontiersin.org/articles/10.3389/fped.2017.00001/full) to assure a gradual increase in oxygenation and blood volume while respirations are being established. This is consistent with providing 21% O2 in the first 30 seconds of respiratory support. The resilient neonate will typically respond in the first 30 seconds, and when continued respiratory support is required, titration O2 levels is appropriate, based on heart rate or SPO2 levels. Including information on underlying physiology is very helpful to support continued learning for those providing neonatal resuscitation, and to illustrate why 21% O2 is appropriate. Use of 21% O2 also would allow for initial PPV at the field during cesarean with a sterile bag-valve-mask device, while maintaining an intact cord during initiation of respirations.