Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia.

Abstract

OBJECTIVE:

To evaluate whether infants with congenital diaphragmatic hernia (CDH) can be safely resuscitated with a reduced starting fraction of inspired oxygen (FiO2) of 0.5.

STUDY DESIGN:

A retrospective cohort study comparing 68 patients resuscitated with starting FiO2 0.5 to 45 historical controls resuscitated with starting FiO2 1.0.

RESULTS:

Reduced starting FiO2 had no adverse effect upon survival, duration of intubation, need for ECMO, duration of ECMO, or time to surgery. Furthermore, it produced no increase in complications, adverse neurological events, or neurodevelopmental delay. The need to subsequently increase FiO2 to 1.0 was associated with female sex, lower gestational age, liver up, lower lung volume-head circumference ratio, decreased survival, a higher incidence of ECMO, longer time to surgery, periventricular leukomalacia, and lower neurodevelopmental motor scores.

CONCLUSION:

Starting FiO2 0.5 may be safe for the resuscitation of CDH infants. The need to increase FiO2 to 1.0 during resuscitation is associated with worse outcomes.

• Authors: John S Riley, Ryan M Antiel, Natalie E Rintoul, Anne M Ades, Lindsay N Waqar, Nan Lin, Lisa M Herkert, Jo Ann D'Agostino, Casey Hoffman, William H Peranteau, Alan W Flake, N Scott Adzick, Holly L Hedrick
• Journal: Journal of perinatology : official journal of the California Perinatal Association (J Perinatol) Vol. 38 Issue 7 Pg. 834-843 (07 2018) ISSN: 1476-5543 [Electronic] United States
• PMID: 29887609 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Oxygen

Topics

• Analysis of Variance
• Case-Control Studies
• Extracorporeal Membrane Oxygenation (methods)
• Female
• Hernias, Diaphragmatic, Congenital (diagnosis, mortality, therapy)
• Hospitals, Pediatric
• Humans
• Infant, Newborn
• Infant, Premature
• Intensive Care Units, Neonatal
• Male
• Multivariate Analysis
• Oxygen (therapeutic use)
• Oxygen Consumption (physiology)
• Oxygen Inhalation Therapy (methods)
• Patient Safety
• Philadelphia
• Pressure
• Prognosis
• Resuscitation (methods)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Survival Rate
• Treatment Outcome