Recent discussions
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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
Thank you for the review. Our work with ECEB has a big task of encouraging delayed cord clamping, while starting resuscitations. This is the biggest resistance I find when working globally, including the global north. There could be inclusive diagrams of babies being resuscitated on the maternal abdomen, for fast recovery within the golden minute. I have gotten into the 'teaching habit' of timing how long it takes for providers to 'cut and tie' the cord. This exercise while adding a lot of humor to class, also adds reality for the providers responsible for resuscitation. The lengthy time taken to cut/tie makes an impression and reinforces that starting the stimulation, bag and mask (after suctioning if that is indicated), can be done so effectively with room air, on maternal abdomen, while calling for help, hoping that an additional set of hands shows up to assist when it is time to cut the cord, or change location for better access to surveillance and continued care. -
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
I agree with the findings of the study. I find very few term babies need more than 21% oxygen. -
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. -
ILCOR Staff
Thank you for the review. I agree with the recommendations. -
ILCOR Staff
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, as we are cognizant of harms in preterm animals and increased neonatal mortality in term infants exposed to high initial O2 concentration." -
ILCOR Staff
Thank you for the review. It would be useful to have specific comments on populations that are expected to have high mortality, such as congenital diaphragmatic hernia. Many guidelines (example - see citation) comment on risks, but do not provide specific guidance. Snoek KG, Reiss IK, Greenough A, Capolupo I, Urlesberger B, Wessel L, Storme L, Deprest J, Schaible T, van Heijst A, Tibboel D; CDH EURO Consortium. Standardized Postnatal Management of Infants with Congenital Diaphragmatic Hernia in Europe: The CDH EURO Consortium Consensus - 2015 Update. Neonatology. 2016;110(1):66-74. doi: 10.1159/000444210. Epub 2016 Apr 15. PubMed PMID: 27077664.