17 results on '"Oei JL"'
Search Results
2. Aspects on Oxygenation in Preterm Infants before, Immediately after Birth, and Beyond.
- Author
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Sotiropoulos JX, Saugstad OD, and Oei JL
- Subjects
- Humans, Infant, Newborn, Intensive Care Units, Neonatal, Infant, Premature, Oxygen metabolism, Oxygen blood, Hyperoxia, Hypoxia, Oxygen Inhalation Therapy adverse effects, Oxygen Inhalation Therapy methods
- Abstract
Background: Oxygen is crucial for life but too little (hypoxia) or too much (hyperoxia) may be fatal or cause lifelong morbidity., Summary: In this review, we discuss the challenges of balancing oxygen control in preterm infants during fetal development, the first few minutes after birth, in the neonatal intensive care unit and after hospital discharge, where intensive care monitoring and response to dangerous oxygen levels is more often than not, out of reach with current technologies and services., Key Messages: Appropriate oxygenation is critically important even from before birth, but at no time is the need to strike a balance more important than during the first few minutes after birth, when body physiology is changing at its most rapid pace. Preterm infants, in particular, have a poor control of oxygen balance. Underdeveloped organs, especially of the lungs, require supplemental oxygen to prevent hypoxia. However, they are also at risk of hyperoxia due to immature antioxidant defenses. Existing evidence demonstrate considerable challenges that need to be overcome before we can ensure safe treatment of preterm infants with one of the most commonly used drugs in newborn care, oxygen., (© 2024 The Author(s). Published by S. Karger AG, Basel.)
- Published
- 2024
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3. The role of oxygen in the development and treatment of bronchopulmonary dysplasia.
- Author
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Sotiropoulos JX and Oei JL
- Subjects
- Infant, Infant, Newborn, Humans, Oxygen, Morbidity, Causality, Infant, Premature, Bronchopulmonary Dysplasia prevention & control
- Abstract
Oxygen (O
2 ) is crucial for both the development and treatment of one of the most important consequences of prematurity: bronchopulmonary dysplasia (BPD). In fetal life, the hypoxic environment is important for alveolar development and maturation. After birth, O2 becomes a double-edged sword. While O2 is needed to prevent hypoxia, it also causes oxidative stress leading to a plethora of morbidities, including retinopathy and BPD. The advent of continuous O2 monitoring with pulse oximeters has allowed clinicians to recognize the narrow therapeutic margins of oxygenation for the preterm infant, but more knowledge is needed to understand what these ranges are at different stages of the preterm infant's life, including at birth, in the neonatal intensive care unit and after hospital discharge. Future research, especially in innovative technologies such as automated O2 control and remote oximetry, will improve the understanding and treatment of the O2 needs of infants with BPD., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2023
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4. PROspective Meta-analysis Of Trials of Initial Oxygen in preterm Newborns (PROMOTION): Protocol for a systematic review and prospective meta-analysis with individual participant data on initial oxygen concentration for resuscitation of preterm infants.
- Author
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Sotiropoulos JX, Schmölzer GM, Oei JL, Libesman S, Hunter KE, Williams JG, Webster AC, Tarnow-Mordi WO, Vento M, Asztalos E, Shah PS, Katheria A, and Seidler AL
- Subjects
- Infant, Female, Infant, Newborn, Humans, Prospective Studies, Resuscitation methods, Gestational Age, Meta-Analysis as Topic, Infant, Premature, Oxygen
- Abstract
Background: Clinicians favour low oxygen concentrations when resuscitating preterm infants immediately after birth despite inconclusive evidence to support this practice. Prospective meta-analysis (PMA) is a novel approach where studies are identified as eligible for inclusion in the meta-analysis before their results are known., Aims: To explore whether high (60%) or low (30%) oxygen is associated with greater efficacy and safety for the initial resuscitation (immediately after birth) of preterm infants born at <29 weeks' gestation., Methods: We will conduct a prospective meta-analysis (PMA) with individual participant data (IPD). We will perform a systematic search to identify ongoing RCTs including infants <29 weeks' gestation randomised to high (60%) or low (30%) oxygen for initial resuscitation after birth. IPD will be sought for all infants randomised for the purpose of meta-analysis. We will employ a one-stage random-effects approach to IPD meta-analysis. Potential heterogeneity and the differential effect of high or low oxygen will be explored through subgroup and interaction analyses. The primary outcome of this study is all-cause mortality prior to hospital discharge. There will be a follow-up analysis of neurodevelopmental outcomes once available., Results/conclusion: The results of neonatal outcomes at hospital discharge are expected by 2025, and neurodevelopmental outcomes by 2027., (© 2022 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)
- Published
- 2023
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5. Neurodevelopmental outcomes of preterm infants after randomisation to initial resuscitation with lower (FiO 2 < 0.3) or higher (FiO 2 > 0.6) initial oxygen levels. An individual patient meta-analysis.
- Author
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Oei JL, Kapadia V, Rabi Y, Saugstad OD, Rook D, Vermeulen MJ, Boronat N, Thamrin V, Tarnow-Mordi W, Smyth J, Wright IM, Lui K, van Goudoever JB, Gebski V, and Vento M
- Subjects
- Child, Gestational Age, Humans, Infant, Infant, Newborn, Middle Aged, Oxygen, Resuscitation, Infant, Premature, Infant, Premature, Diseases therapy
- Abstract
Objective: To determine the effects of lower (≤0.3) versus higher (≥0.6) initial fractional inspired oxygen (FiO
2 ) for resuscitation on death and/or neurodevelopmental impairment (NDI) in infants <32 weeks' gestation., Design: Meta-analysis of individual patient data from three randomised controlled trials., Setting: Neonatal intensive care units., Patients: 543 children <32 weeks' gestation., Intervention: Randomisation at birth to resuscitation with lower (≤0.3) or higher (≥0.6) initial FiO2 ., Outcome Measures: Primary: death and/or NDI at 2 years of age.Secondary: post-hoc non-randomised observational analysis of death/NDI according to 5-minute oxygen saturation (SpO2 ) below or at/above 80%., Results: By 2 years of age, 46 of 543 (10%) children had died. Of the 497 survivors, 84 (17%) were lost to follow-up. Bayley Scale of Infant Development (third edition) assessments were conducted on 377 children. Initial FiO2 was not associated with difference in death and/or disability (difference (95% CI) -0.2%, -7% to 7%, p=0.96) or with cognitive scores <85 (2%, -5% to 9%, p=0.5). Five-minute SpO2 >80% was associated with decreased disability/death (14%, 7% to 21%) and cognitive scores >85 (10%, 3% to 18%, p=0.01). Multinomial regression analysis noted decreased death with 5-minute SpO2 ≥80% (odds (95% CI) 09.62, 0.98 to 0.96) and gestation (0.52, 0.41 to 0.65), relative to children without death or NDI., Conclusion: Initial FiO2 was not associated with difference in risk of disability/death at 2 years in infants <32 weeks' gestation but CIs were wide. Substantial benefit or harm cannot be excluded. Larger randomised studies accounting for patient differences, for example, gestation and gender are urgently needed., Competing Interests: Competing interests: YR has patents for technology to guide oxygen titration during newborn resuscitation. He did not contribute to any aspects of the manuscript related to the targeting of oxygen saturation., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2022
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6. The micropreemie: Advances and challenges in treating the smallest newborn infants.
- Author
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Kusuda S and Oei JL
- Subjects
- Humans, Infant, Infant, Newborn, Infant Care, Infant, Premature
- Published
- 2022
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7. Oxygen saturation (SpO2) targeting for newborn infants at delivery: Are we reaching for an impossible unknown?
- Author
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Gottimukkala SB, Sotiropoulos JX, Lorente-Pozo S, Monti Sharma A, Vento M, Saugstad OD, and Oei JL
- Subjects
- Humans, Infant, Infant, Newborn, Oxygen, Resuscitation, Infant, Premature, Oximetry
- Abstract
For more than 200 years, pure oxygen was given ad libitum to newborn infants requiring resuscitation. Due to oxidative stress and injury concerns, a paradigm shift towards using "less" oxygen, including air (21% oxygen) instead of pure (100%) oxygen, occurred about twenty years ago. A decade later, clinicians were advised to adjust fractional inspired oxygen (FiO
2 ) to target oxygen saturations (SpO2 ) that were derived from spontaneously breathing, healthy, mature infants. Whether these recommendations are achievable, beneficial, harmful or redundant is uncertain. The underlying pathology leading to resuscitation varies between infants and may considerably alter an infant's response to supplemental oxygen. In this review, we summarize available evidence for the use of SpO2 monitoring at delivery for newborn infants, elucidate existing knowledge and service gaps, and suggest future research recommendations that will lead to the safest clinical strategies for this standard and important practice., (Copyright © 2021. Published by Elsevier Ltd.)- Published
- 2021
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8. Optimizing oxygen therapy for preterm infants at birth: Are we there yet?
- Author
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Kapadia V and Oei JL
- Subjects
- Calibration, Delivery Rooms standards, Female, Humans, Infant, Infant, Newborn, Infant, Premature, Diseases therapy, Oxygen administration & dosage, Parturition physiology, Pregnancy, Resuscitation, Infant, Premature, Oxygen Inhalation Therapy methods, Oxygen Inhalation Therapy standards
- Abstract
Premature infants undergo a complex postnatal adaptation at birth. For last two centuries, oxygen has been integral to respiratory support of preterm infants at birth. Excess oxygen can cause oxidative stress and tissue injury. Preterm infants due to lung immaturity may need oxygen for successful transition at birth. Although, considerable progress has been made in the last 3 decades, optimum oxygen therapy for preterm delivery room resuscitation remains unknown. In this review, we discuss the history and physiology behind oxygen therapy in the delivery room, evaluate current literature, provide practice points and point out knowledge gaps of oxygen therapy in preterm infant at birth., (© 2020 Published by Elsevier Ltd.)
- Published
- 2020
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9. Diaphragm-triggered non-invasive respiratory support in preterm infants.
- Author
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Goel D, Oei JL, Smyth J, and Schindler T
- Subjects
- Continuous Positive Airway Pressure, Humans, Infant, Newborn, Interactive Ventilatory Support, Intermittent Positive-Pressure Ventilation, Randomized Controlled Trials as Topic, Diaphragm physiology, Infant, Premature
- Abstract
Background: Diaphragm-triggered non-invasive respiratory support, commonly referred to as NIV-NAVA (non-invasive neurally adjusted ventilatory assist), uses the electrical activity of the crural diaphragm to trigger the start and end of a breath. It provides variable inspiratory pressure that is proportional to an infant's changing inspiratory effort. NIV-NAVA has the potential to provide effective, non-invasive, synchronised, multilevel support and may reduce the need for invasive ventilation; however, its effects on short- and long-term outcomes, especially in the preterm infant, are unclear., Objectives: To assess the effectiveness and safety of diaphragm-triggered non-invasive respiratory support in preterm infants (< 37 weeks' gestation) when compared to other non-invasive modes of respiratory support (nasal intermittent positive pressure ventilation (NIPPV); nasal continuous positive airway pressure (nCPAP); high-flow nasal cannulae (HFNC)), and to assess preterm infants with birth weight less than 1000 grams or less than 28 weeks' corrected gestation at the time of intervention as a sub-group., Search Methods: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2019, Issue 5), MEDLINE via PubMed (1946 to 10 May 2019), Embase (1947 to 10 May 2019), and CINAHL (1982 to 10 May 2019). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials., Selection Criteria: Randomised and quasi-randomised controlled trials that compared diaphragm-triggered non-invasive versus other non-invasive respiratory support in preterm infants., Data Collection and Analysis: Two review authors independently selected trials, assessed trial quality and extracted data from included studies. We performed fixed-effect analyses and expressed treatment effects as mean difference (MD), risk ratio (RR), and risk difference (RD) with 95% confidence intervals (CIs). We used the generic inverse variance method to analyse specific outcomes for cross-over trials. We used the GRADE approach to assess the certainty of evidence., Main Results: There were two small randomised controlled trials including a total of 23 infants eligible for inclusion in the review. Only one trial involving 16 infants included in the analysis reported on either of the primary outcomes of the review. This found no difference in failure of modality between NIV-NAVA and NIPPV (RR 0.33, 95% CI 0.02 to 7.14; RD -0.13, 95% CI -0.41 to 0.16; 1 study, 16 infants; heterogeneity not applicable). Both trials reported on secondary outcomes of the review, specific for cross-over trials (total 22 infants; 1 excluded due to failure of initial modality). One study involving seven infants reported a significant reduction in maximum FiO₂ with NIV-NAVA compared to NIPPV (MD -4.29, 95% CI -5.47 to -3.11; heterogeneity not applicable). There was no difference in maximum electric activity of the diaphragm (Edi) signal between modalities (MD -1.75, 95% CI -3.75 to 0.26; I² = 0%) and a significant increase in respiratory rate with NIV-NAVA compared to NIPPV (MD 7.22, 95% CI 0.21 to 14.22; I² = 72%) on a meta-analysis of two studies involving a total of 22 infants. The included studies did not report on other outcomes of interest., Authors' Conclusions: Due to limited data and very low certainty evidence, we were unable to determine if diaphragm-triggered non-invasive respiratory support is effective or safe in preventing respiratory failure in preterm infants. Large, adequately powered randomised controlled trials are needed to determine if diaphragm-triggered non-invasive respiratory support in preterm infants is effective or safe., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)
- Published
- 2020
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10. Oxygen therapy of the newborn from molecular understanding to clinical practice.
- Author
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Saugstad OD, Oei JL, Lakshminrusimha S, and Vento M
- Subjects
- Animals, Asphyxia Neonatorum diagnosis, Asphyxia Neonatorum metabolism, Asphyxia Neonatorum physiopathology, DNA Damage, Gestational Age, Humans, Hyperoxia etiology, Infant, Newborn, Inflammation Mediators metabolism, Lung metabolism, Oxidative Stress, Risk Assessment, Risk Factors, Treatment Outcome, Asphyxia Neonatorum therapy, Infant, Premature, Lung physiopathology, Oxygen Inhalation Therapy adverse effects, Premature Birth
- Abstract
Oxygen is one of the most critical components of life. Nature has taken billions of years to develop optimal atmospheric oxygen concentrations for human life, evolving from very low, peaking at 30% before reaching 20.95%. There is now increased understanding of the potential toxicity of both too much and too little oxygen, especially for preterm and asphyxiated infants and of the potential and lifelong impact of oxygen exposure, even for a few minutes after birth. In this review, we discuss the contribution of knowledge gleaned from basic science studies and their implication in the care and outcomes of the human infant within the first few minutes of life and afterwards. We emphasize current knowledge gaps and research that is needed to answer a problem that has taken Nature a considerably longer time to resolve.
- Published
- 2019
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11. Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO 2 0.21 or 1.0.
- Author
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Thamrin V, Saugstad OD, Tarnow-Mordi W, Wang YA, Lui K, Wright IM, De Waal K, Travadi J, Smyth JP, Craven P, McMullan R, Coates E, Ward M, Mishra P, See KC, Cheah IGS, Lim CT, Choo YM, Kamar AA, Cheah FC, Masoud A, and Oei JL
- Subjects
- Aptitude Tests, Child, Preschool, Female, Follow-Up Studies, Gestational Age, Humans, Infant, Newborn, Male, Oxygen blood, Infant, Premature, Neurodevelopmental Disorders epidemiology, Oxygen administration & dosage, Oxygen Inhalation Therapy methods, Resuscitation
- Abstract
Objective: To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children <32 weeks' gestation randomized to initial resuscitation with a fraction of inspired oxygen (FiO
2 ) value of 0.21 or 1.0., Study Design: Blinded assessments were conducted at 2-3 years corrected age with the Bayley Scales of Infant and Toddler Development, Third Edition or the Ages and Stages Questionnaire by intention to treat., Results: Of the 290 children enrolled, 40 could not be contacted and 10 failed to attend appointments. Among the 240 children for whom outcomes at age 2 years were available, 1 child had a lethal congenital anomaly, 1 child had consent for follow-up withdrawn, and 23 children died. The primary outcome, which was available in 238 (82%) of those randomized, occurred in 47 of the 117 (40%) children assigned to initial FiO2 0.21 and in 38 of the 121 (31%) assigned to initial FiO2 1.0 (OR, 1.47; 95% CI, 0.86-2.5; P = .16). No difference in NDI was found in 215 survivors randomized to FiO2 0.21 vs 1.0 (OR, 1.26; 95% CI, 0.70-2.28; P = .11). In post hoc exploratory analyses in the whole cohort, children with a 5-minute blood oxygen saturation (SpO2 ) <80% were more likely to die or to have NDI (OR, 1.85; 95% CI, 1.07-3.2; P = .03)., Conclusions: Initial resuscitation of infants <32 weeks' gestation with initial FiO2 0.21 had no significant effect on death or NDI compared with initial FiO2 1.0. Further evaluation of optimum initial FiO2 , including SpO2 targeting, in a large randomized controlled trial is needed., Trial Registration: Australian and New Zealand Clinical Trials Network Registry ACTRN 12610001059055 and the National Malaysian Research Registry NMRR-07-685-957., (Copyright © 2018 Elsevier Inc. All rights reserved.)- Published
- 2018
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12. Lower versus higher oxygen concentrations titrated to target oxygen saturations during resuscitation of preterm infants at birth.
- Author
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Lui K, Jones LJ, Foster JP, Davis PG, Ching SK, Oei JL, and Osborn DA
- Subjects
- Cerebral Hemorrhage epidemiology, Child, Preschool, Enterocolitis, Necrotizing epidemiology, Humans, Infant, Infant Mortality, Infant, Newborn, Intubation, Intratracheal statistics & numerical data, Lung Diseases epidemiology, Neurodevelopmental Disorders epidemiology, Neurodevelopmental Disorders etiology, Randomized Controlled Trials as Topic, Retinopathy of Prematurity epidemiology, Infant, Premature blood, Oxygen administration & dosage, Oxygen analysis, Resuscitation adverse effects, Resuscitation methods
- Abstract
Background: Initial resuscitation with air is well tolerated by most infants born at term. However, the optimal fractional inspired oxygen concentration (FiO
2 - proportion of the breathed air that is oxygen) targeted to oxygen saturation (SpO2 - an estimate of the amount of oxygen in the blood) for infants born preterm is unclear., Objectives: To determine whether lower or higher initial oxygen concentrations, when titrated according to oxygen saturation targets during the resuscitation of preterm infants at birth, lead to improved short- and long-term mortality and morbidity., Search Methods: We conducted electronic searches of the Cochrane Central Register of Controlled Trials (13 October 2017), Ovid MEDLINE (1946 to 13 October 2017), Embase (1974 to 13 October 2017) and CINAHL (1982 to 13 October 2017); we also searched previous reviews (including cross-references), contacted expert informants, and handsearched journals., Selection Criteria: We included randomised controlled trials (including cluster- and quasi-randomised trials) which enrolled preterm infants requiring resuscitation following birth and allocated them to receive either lower (FiO2 < 0.4) or higher (FiO2 ≥ 0.4) initial oxygen concentrations titrated to target oxygen saturation., Data Collection and Analysis: Two review authors independently assessed the eligibility of studies for inclusion, extracted data and assessed methodological quality. Primary outcomes included mortality near term or at discharge (latest reported) and neurodevelopmental disability. We conducted meta-analysis using a fixed-effect model. We assessed the quality of the evidence using GRADE., Main Results: The search identified 10 eligible trials. Meta-analysis of the 10 included studies (914 infants) showed no difference in mortality to discharge between lower (FiO2 < 0.4) and higher (FiO2 ≥ 0.4) initial oxygen concentrations targeted to oxygen saturation (risk ratio (RR) 1.05, 95% confidence interval (CI) 0.68 to 1.63). We identified no heterogeneity in this analysis. We graded the quality of the evidence as low due to risk of bias and imprecision. There were no significant subgroup effects according to inspired oxygen concentration strata (FiO2 0.21 versus ≥ 0.4 to < 0.6; FiO2 0.21 versus ≥ 0.6 to 1.0; and FiO2 ≥ 0.3 to < 0.4 versus ≥ 0.6 to 1.0). Subgroup analysis identified a single trial that reported increased mortality from use of lower (FiO2 0.21) versus higher (FiO2 1.0) initial oxygen concentration targeted to a lowest SpO2 of less than 85%, whereas meta-analysis of nine trials targeting a lowest SpO2 of 85% to 90% found no difference in mortality.Meta-analysis of two trials (208 infants) showed no difference in neurodevelopmental disability at 24 months between infants receiving lower (FiO2 < 0.4) versus higher (FiO2 > 0.4) initial oxygen concentrations targeted to oxygen saturation. Other outcomes were incompletely reported by studies. Overall, we found no difference in use of intermittent positive pressure ventilation or intubation in the delivery room; retinopathy (damage to the retina of the eyes, measured as any retinopathy and severe retinopathy); intraventricular haemorrhage (any and severe); periventricular leukomalacia (a type of white-matter brain injury); necrotising enterocolitis (a condition where a portion of the bowel dies); chronic lung disease at 36 weeks' gestation; mortality to follow up; postnatal growth failure; and patent ductus arteriosus. We graded the quality of the evidence for these outcomes as low or very low., Authors' Conclusions: There is uncertainty as to whether initiating post birth resuscitation in preterm infants using lower (FiO2 < 0.4) or higher (FiO2 ≥ 0.4) oxygen concentrations, targeted to oxygen saturations in the first 10 minutes, has an important effect on mortality or major morbidity, intubation during post birth resuscitation, other resuscitation outcomes, and long-term outcomes including neurodevelopmental disability. We assessed the quality of the evidence for all outcomes as low to very low. Further large, well designed trials are needed to assess the effect of using different initial oxygen concentrations and the effect of targeting different oxygen saturations.- Published
- 2018
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13. Placing preterm infants on their side at birth does not increase 5 min SpO 2 .
- Author
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Oei JL
- Subjects
- Humans, Infant, Newborn, Infant, Premature, Oximetry
- Published
- 2017
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14. Targeted Oxygen in the Resuscitation of Preterm Infants, a Randomized Clinical Trial.
- Author
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Oei JL, Saugstad OD, Lui K, Wright IM, Smyth JP, Craven P, Wang YA, McMullan R, Coates E, Ward M, Mishra P, De Waal K, Travadi J, See KC, Cheah IG, Lim CT, Choo YM, Kamar AA, Cheah FC, Masoud A, and Tarnow-Mordi W
- Subjects
- Air, Child, Preschool, Disabled Children, Female, Follow-Up Studies, Gestational Age, Hospital Mortality, Humans, Infant, Infant, Newborn, Intensive Care Units, Neonatal, Male, Oximetry methods, Oxygen Inhalation Therapy adverse effects, Resuscitation mortality, Risk, Infant, Premature, Oxygen Inhalation Therapy methods, Resuscitation methods
- Abstract
Background and Objectives: Lower concentrations of oxygen (O
2 ) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants <32 weeks' gestation., Methods: A randomized, unmasked study designed to determine major disability and death at 2 years in infants <32 weeks' gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission., Results: Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144; 100% O2 : n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2 . In non-prespecified analyses, infants <28 weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%]; than those given 100% O2 : 3 of 54 [6%]; risk ratio: 3.9 [95% confidence interval: 1.1-13.4]; P = .01). Respiratory failure was the most common cause of death (n = 13)., Conclusions: Using RA to initiate resuscitation was associated with an increased risk of death in infants <28 weeks' gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed., (Copyright © 2017 by the American Academy of Pediatrics.)- Published
- 2017
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15. Higher or lower oxygen for delivery room resuscitation of preterm infants below 28 completed weeks gestation: a meta-analysis.
- Author
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Oei JL, Vento M, Rabi Y, Wright I, Finer N, Rich W, Kapadia V, Aune D, Rook D, Tarnow-Mordi W, and Saugstad OD
- Subjects
- Delivery Rooms, Dose-Response Relationship, Drug, Gestational Age, Humans, Infant, Newborn, Infant, Premature, Infant, Premature, Diseases therapy, Oxygen administration & dosage, Oxygen Inhalation Therapy methods, Resuscitation methods
- Abstract
Objective: To systematically review outcomes of infants ≤28+6 weeks gestation randomised to resuscitation with low (≤0.3) vs high (≥0.6) fraction of inspired oxygen (FiO
2 ) at delivery., Design: Systematic review of randomised controlled trials of low (≤0.3) vs high (≥0.6) FiO2 resuscitation. Information was obtained from databases (Medline/Pub Med, EMBASE, ClinicalTrials.gov, Cochrane) and meeting abstracts between 1990 to 2015. Search index terms: preterm/ resuscitation/oxygen. Data for infants ≤28+6 weeks gestation were independently extracted and pooled using a random effects model. Analyses were performed with Revman V.5., Main Outcome Measures: Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC)., Results: A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04)., Conclusions: There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (≤0.30) or higher (≥0.6) FiO2 in infants ≤28+6 weeks gestation. The opposing results for masked and unmasked trials may represent a Type I error, emphasising the need for larger, well designed studies., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)- Published
- 2017
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16. Use of oxygen in the resuscitation of preterm infants: current opinion and practice in Australia and New Zealand.
- Author
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Clark RL, Lui K, and Oei JL
- Subjects
- Adult, Asphyxia Neonatorum therapy, Attitude of Health Personnel, Australia, Bronchopulmonary Dysplasia etiology, Humans, Infant, Newborn, Middle Aged, New Zealand, Oximetry, Oxygen Inhalation Therapy adverse effects, Resuscitation adverse effects, Retinopathy of Prematurity etiology, Surveys and Questionnaires, Young Adult, Infant, Premature, Intensive Care, Neonatal methods, Oxygen administration & dosage, Oxygen Inhalation Therapy methods, Resuscitation methods
- Abstract
Aim: The aim of this paper was to explore the opinions and practices of tertiary health-care professionals in Australia and New Zealand regarding air and oxygen blending (OB) for the resuscitation of preterm infants., Methods: Structured questionnaires were sent to the directors of 25 tertiary perinatal units, with instructions to distribute the questionnaires to 15 pertinent clinical staff., Results: Response rate was 72% (n = 271); medical-staff response was 25%. Sixteen (64%) perinatal units had OB resuscitation equipment. Among respondents, 114 (42%) had access to OB and 73 (27%) had OB for all resuscitations. Pulse oximetry was available to 160 (59%) of respondents. The majority (173, 64%) would initiate resuscitation with Fractional inspired oxygen (FiO(2)) ranging from 0.3 to 0.9 (mean 0.5), with 15% and 21% preferring air and 100% oxygen, respectively. There were large variations in managing FiO(2) changes thereafter. Half of the respondents were either unsure (39%) or not convinced (15%) that 100% oxygen during resuscitation would cause harm. Conversely, 42% suggested that OB might improve outcome with bronchopulmonary dysplasia and retinopathy of prematurity being the most important considerations. Most (92%) would advocate for OB in the delivery suite. Set-up cost (50%) and lack of guided experience (38%) ranked highest as barriers to change., Conclusions: Two-thirds of the tertiary centres have at least some OB equipment in the delivery suite, but the ways and opinions in which OB is utilised differ widely. Most practitioners would advocate for a change. There is an urgent need for further research to achieve a consistent and meaningful clinical management for OB resuscitation of preterm infants.
- Published
- 2009
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17. Preterm Infant Outcomes after Randomization to Initial Resuscitation with FiO 2 0.21 or 1.0
- Author
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Thamrin, V, Saugstad, OD, Tarnow-Mordi, W, Wang, YA, Lui, K, Wright, IM, De Waal, K, Travadi, J, Smyth, JP, Craven, P, McMullan, R, Coates, E, Ward, M, Mishra, P, See, KC, Cheah, IGS, Lim, CT, Choo, YM, Kamar, AA, Cheah, FC, Masoud, A, and Oei, JL
- Subjects
Male ,Resuscitation ,Oxygen Inhalation Therapy ,Infant, Newborn ,Gestational Age ,Pediatrics ,Oxygen ,Aptitude Tests ,Neurodevelopmental Disorders ,Child, Preschool ,Humans ,Female ,Infant, Premature ,Follow-Up Studies - Abstract
© 2018 Elsevier Inc. Objective: To determine rates of death or neurodevelopmental impairment (NDI) at 2 years corrected age (primary outcome) in children
- Published
- 2018
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