Differential Alveolar and Systemic Oxygenation during Preterm Resuscitation with 100% Oxygen during Delayed Cord Clamping

Satyan Lakshminrusimha, Payam Vali, Praveen Chandrasekharan, Wade Rich, Anup Katheria

Research output: Contribution to journalArticlepeer-review

Abstract

Objective  Delayed cord clamping (DCC) and 21 to 30% O 2 resuscitation is recommended for preterm infants but is commonly associated with low pulmonary blood flow (Qp) and hypoxia. 100% O 2 supplementation during DCC for 60 seconds followed by 30% O 2 may increase Qp and oxygen saturation (SpO 2). Study Design  Preterm lambs (125-127 days of gestation) were resuscitated with 100% O 2 with immediate cord clamping (ICC, n = 7) or ICC + 30% O 2, and titrated to target SpO 2 (n = 7) or DCC + 100% O 2 for 60 seconds, which followed by cord clamping and 30% O 2 titration (n = 7). Seven preterm (23-27 weeks of gestation) human infants received continuous positive airway pressure (CPAP) + 100% O 2 for 60 seconds during DCC, cord clamping, and 30% O 2 supplementation after cord clamping. Results  Preterm lambs in the ICC + 100% O 2 group resulted in PaO 2 (77 ± 25 mmHg), SpO 2 (77 ± 11%), and Qp (27 ± 9 mL/kg/min) at 60 seconds. ICC + 30% O 2 led to low Qp (14 ± 3 mL/kg/min), low SpO 2 (43 ± 26%), and PaO 2 (19 ± 7 mmHg). DCC + 100% O 2 led to similar Qp (28 ± 6 mL/kg/min) as ICC + 100% O 2 with lower PaO 2. In human infants, DCC + CPAP with 100% O 2 for 60 seconds, which followed by weaning to 30% resulted in SpO 2 of 92 ± 11% with all infants >80% at 5 minutes with 100% survival without severe intraventricular hemorrhage. Conclusion  DCC + 100% O 2 for 60 seconds increased Qp probably due to transient alveolar hyperoxia with systemic normoxia due to dilution by umbilical venous return. Larger translational and clinical studies are warranted to confirm these findings. Key Points Transient alveolar hyperoxia during delayed cord clamping can enhance pulmonary vasodilation. Placental transfusion buffers systemic oxygen tension and limits hyperoxia. Use of 100% oxygen for 60 seconds during DCC was associated with SpO 2 ≥80% by 5 minutes.

Original languageEnglish (US)
JournalAmerican journal of perinatology
DOIs
StateAccepted/In press - 2021

Keywords

  • delayed cord clamping
  • neonatology
  • oxygen
  • resuscitaiton

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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