Open AccessHOW MUCH OXYGEN IS NECESSARY? NEW PARADIGM OF NEONATAL RESUSCITATION
Author(s) -
Y.S. Korzhynskyy
Publication year - 2013
Publication title -
neonatologìâ, hìrurgìâ ta perinatalʹna medicina
Language(s) - English
Resource type - Journals
eISSN - 2413-4260
pISSN - 2226-1230
DOI - 10.24061/2413-4260.iii.2.8.2013.13
Subject(s) - resuscitation , hyperoxia , neonatal resuscitation , medicine , hypoxia (environmental) , oxygen , room air distribution , fraction of inspired oxygen , oxygen therapy , anesthesia , oxidative stress , supplemental oxygen , oxygen delivery , intensive care medicine , chemistry , mechanical ventilation , lung , physics , organic chemistry , thermodynamics
. At the end of the last decade the reevaluation of the data concerning oxygen use inthe newborn resuscitation took place. So-calledphenomenon of the “oxygen paradox” existswhen oxygen administration at the background ofexisting hypoxia in species that cannot live withoutoxygen causes oxidative stress and tissue damagein addition to the hypoxic injury. Oxydativestress correlates with inflammation, cell growth,proliferation and differentiation. Hyperoxia causeslung injury, suppresses alveolarisation and lunggrowth, affects adversely the immature nervoussystem. Meta-analysis of 10 randomised and quasirandomized clinical studies confirmed decrease ofmortality rate of term newborns in the case of theinitiation of resuscitation with room air comparedto 100% oxygen. In 2010 an international consensusconcerning neonatal resuscitation was accepted withrecommendations to use room air instead of oxygenas the initial resuscitation gas. Data concerningresuscitation of premature infants are somewhatlimited. Administration of room air as the initial gasmay be insufficient for the achievement of desiredoxygenation whereas 100% oxygen causes excessiveoxygenation. Titration of the oxygen fraction inthe air-oxygen mixture during resuscitation isrecommended focusing on the targeted saturationvalues.