Recent discussions
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ILCOR Staff
Thank you -
ILCOR Staff
We agree absolutely that ensuring adequate ventilation is essential although this PICOST and the studies included did not specifically address and report on the adequacy of ventilation. -
ILCOR Staff
Thank you for your comments. Your assertions about the brain requirements for oxygen are interesting but not born out by pragmatic randomised controlled trials comparing 21% vs 100%. The recommendation does not advocate maintaining hypoxic for 10 minutes in any circumstance. In fact it is a recommendation for concentration at which to commence resuscitation. ILCOR and the neonatal group exist to examine evidence for practice in terms of resuscitation. Certainly more evidence is required to hone recommendations and improve care but we must guard against implementing change based upon mere unproven opinion be it medical or legal. In the past that approach has led to serious harm in neonatology. This PICOST addressed the evidence for the initial oxygen concentration at which to commence resuscitation of the newborn. -
ILCOR Staff
Thank you -
ILCOR Staff
You may want to do this but whilst there may be theoretical advantages to such an approach we need to be aware that they are unproven. Therefore for this international CoSTR we could not recommend such an approach in the absence of evidence to support it. Guideline authors, or institutions may choose to alter approaches for specific groups. If they do it would be helpful to publish results. -
ILCOR Staff
Thank you. This was not the focus of the PICOST and there is insufficient data to define this. It will in fact vary according to the current clinical practice and level of resources available. If BVM is used in a low resource setting the cost of 21% is zero. However, if T-piece is used and piped air is required the cost may be significant. It will need institutions or health economies to look at this locally. -
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 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.