Recent discussions
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ILCOR Staff
I agree with findings of study. -
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
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
I agree -
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%.