Recent discussions
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Gislayne Nieto
i agree with screening of during the rescusitation
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Helenilce Costa
I agree that further study is necessary. Necessity of FiO2 > 0,5 has not been observed.
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Gislayne Nieto
Concerns persist regarding unmeasured but I sugest more than 30% fio2 for start
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José Roberto Ramos
I agree with the proposed recommendation.
It will help a lot in the practice and teaching of laryngoscopy
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José Roberto Ramos
according gestational age and for extreme preterm ( less than 28 wks GA. My suggestion is
- Above 30 e below 50%
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Jayasree Nair
We appreciate the ability to comment on this upcoming ILCOR statement . Our discussions involved Neonatal Fellows and Faculty, frontline providers at high-risk deliveries. Below represents a consensus of opinion.
We urge ILCOR to consider rewording their recommendation “begin resuscitation with more than 30% oxygen” for < 32 wk infants. A distinct change from 2020 recommendations for initiating resuscitation in <35 wk infants with 21-30% O2, this seems to be primarily based on the NETMOTION meta-analysis. This intriguing network & IPD meta-analyses showed lower mortality in >90% compared to the other 2 groups <30% & 50-65% (weak/very weak recommendations). While thought provoking, individual study limitations remain, such as heterogeneity in setting (both well and poorly resourced, with/without availability of oxygen blenders) and patient population (AGA/SGA infants etc.). Except for one study, (Oei et al) the cause/s and timing of mortality is unclear. Trying to link a few minutes of starting O2 to mortality in the absence of such data is difficult.
Practically, clinicians here have initiated preterm resuscitation with 30% O2. In most other DR`s, clinicians likely start at 21% or 30%, as recommended.. “More than 30%” implies that a clinician who starts resuscitation at 30% would not be adhering to recommendations while starting at 31% would be compatible. Could rewording the statement to “30% or higher” support current science while being less of a drastic and unclear change?
The third statement “Subsequent titration of O2 using pulse oximetry is advised” could be more impactful if included with the initial sentence as “Among newborn infants <32 wks’, it is reasonable to begin resuscitation with 30% or higher O2 with subsequent titration using pulse oximetry”. When using higher oxygen, titrating O2 delivery based on pulse oximetry is critical. If used as currently formulated, we consider the word “advise” weak. We would suggest using “recommended”. If blenders are unavailable, the word “recommended” should force guiding councils to consider making them available.
Physiologically, heart rate response is as important as O2 saturations in a resuscitation. A lower HR, eg 60-100/min, could lead to the clinician turning up the O2 even if the saturations are near target range. Is this a knowledge gap that could be explored with existing data or in future studies?
Nair J, Ahn E, DeBenedictis N, Hartman C, Lee Y, Mansfield J, Muthalaly R, Kim J, Perlman J.
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Aurimery Chermont
- Glucose therapies relevant to resuscitation include exogenous dextrose (intravenous, intraosseous, buccal) and glucagon (intramuscular, intravenous). These could be given during resuscitation in infants with poor response or in post-resuscitation care, with or without prior glucose monitoring. In post-resuscitation care, glucose therapies could be provided as part of a bundles of care.
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Aurimery Chermont
The use of videolaringoscopy is very useful in a premature less than 1000g. can be recommended.
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Aurimery Chermont
- Comparison of different devices to support resuscitation with an intact cord should be undertaken
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Aurimery Chermont
Future studies should address these outcomes. Sufficiently powered trials to investigate a difference in the critical outcomes severe intraventricular hemorrhage and periventricular leukomalacia should also be considered.