Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration

Munmun Rawat, Praveen K. Chandrasekharan, Daniel D. Swartz, Bobby Mathew, Jayasree Nair, Sylvia F. Gugino, Carmon Koenigsknecht, Payam Vali, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background:The Neonatal Resuscitation Program (NRP) recommends upper and lower limits of preductal saturations (SpO 2) extrapolated from studies in infants resuscitated in room air. These limits have not been validated in asphyxia and lung disease.Methods:Seven control term lambs delivered by cesarean section were ventilated with 21% O 2. Thirty lambs with asphyxia with meconium aspiration were randomly assigned to resuscitation with 21% O2 (n = 6), 100% O2 (n = 6), or initiation with 21% O2 followed by variable FIO2 to maintain NRP target SpO2 ranges (n = 18). Hemodynamic and ventilation parameters were recorded for 15 min.Results:Control lambs maintained preductal SpO2 near the lower limit of NRP target range. Asphyxiated lambs had low SpO2 (38 ± 2%), low arterial pH (6.99 ± 0.01), and high PaCO2 (96 ± 7 mm Hg) at birth. Resuscitation with 21% O2 resulted in SpO2 values below the target range with low pulmonary blood flow (Qp) compared to variable FIO2 group. The increase in PaO2 and Qp with variable FIO2 resuscitation was similar to control lambs. Conclusion:Maintaining SpO2 as recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and higher Qp in asphyxiated lambs with lung disease. Our findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.

Original languageEnglish (US)
Pages (from-to)583-588
Number of pages6
JournalPediatric Research
Volume79
Issue number4
DOIs
StatePublished - Apr 1 2016
Externally publishedYes

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Meconium Aspiration Syndrome
Resuscitation
Guidelines
Oxygen
Asphyxia
Lung Diseases
Cesarean Section
Ventilation
Hemodynamics
Air
Parturition
Newborn Infant

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration. / Rawat, Munmun; Chandrasekharan, Praveen K.; Swartz, Daniel D.; Mathew, Bobby; Nair, Jayasree; Gugino, Sylvia F.; Koenigsknecht, Carmon; Vali, Payam; Lakshminrusimha, Satyanarayana.

In: Pediatric Research, Vol. 79, No. 4, 01.04.2016, p. 583-588.

Research output: Contribution to journalArticle

Rawat, M, Chandrasekharan, PK, Swartz, DD, Mathew, B, Nair, J, Gugino, SF, Koenigsknecht, C, Vali, P & Lakshminrusimha, S 2016, 'Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration', Pediatric Research, vol. 79, no. 4, pp. 583-588. https://doi.org/10.1038/pr.2015.259
Rawat, Munmun ; Chandrasekharan, Praveen K. ; Swartz, Daniel D. ; Mathew, Bobby ; Nair, Jayasree ; Gugino, Sylvia F. ; Koenigsknecht, Carmon ; Vali, Payam ; Lakshminrusimha, Satyanarayana. / Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration. In: Pediatric Research. 2016 ; Vol. 79, No. 4. pp. 583-588.
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abstract = "Background:The Neonatal Resuscitation Program (NRP) recommends upper and lower limits of preductal saturations (SpO 2) extrapolated from studies in infants resuscitated in room air. These limits have not been validated in asphyxia and lung disease.Methods:Seven control term lambs delivered by cesarean section were ventilated with 21{\%} O 2. Thirty lambs with asphyxia with meconium aspiration were randomly assigned to resuscitation with 21{\%} O2 (n = 6), 100{\%} O2 (n = 6), or initiation with 21{\%} O2 followed by variable FIO2 to maintain NRP target SpO2 ranges (n = 18). Hemodynamic and ventilation parameters were recorded for 15 min.Results:Control lambs maintained preductal SpO2 near the lower limit of NRP target range. Asphyxiated lambs had low SpO2 (38 ± 2{\%}), low arterial pH (6.99 ± 0.01), and high PaCO2 (96 ± 7 mm Hg) at birth. Resuscitation with 21{\%} O2 resulted in SpO2 values below the target range with low pulmonary blood flow (Qp) compared to variable FIO2 group. The increase in PaO2 and Qp with variable FIO2 resuscitation was similar to control lambs. Conclusion:Maintaining SpO2 as recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and higher Qp in asphyxiated lambs with lung disease. Our findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.",
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T1 - Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration

AU - Rawat, Munmun

AU - Chandrasekharan, Praveen K.

AU - Swartz, Daniel D.

AU - Mathew, Bobby

AU - Nair, Jayasree

AU - Gugino, Sylvia F.

AU - Koenigsknecht, Carmon

AU - Vali, Payam

AU - Lakshminrusimha, Satyanarayana

PY - 2016/4/1

Y1 - 2016/4/1

N2 - Background:The Neonatal Resuscitation Program (NRP) recommends upper and lower limits of preductal saturations (SpO 2) extrapolated from studies in infants resuscitated in room air. These limits have not been validated in asphyxia and lung disease.Methods:Seven control term lambs delivered by cesarean section were ventilated with 21% O 2. Thirty lambs with asphyxia with meconium aspiration were randomly assigned to resuscitation with 21% O2 (n = 6), 100% O2 (n = 6), or initiation with 21% O2 followed by variable FIO2 to maintain NRP target SpO2 ranges (n = 18). Hemodynamic and ventilation parameters were recorded for 15 min.Results:Control lambs maintained preductal SpO2 near the lower limit of NRP target range. Asphyxiated lambs had low SpO2 (38 ± 2%), low arterial pH (6.99 ± 0.01), and high PaCO2 (96 ± 7 mm Hg) at birth. Resuscitation with 21% O2 resulted in SpO2 values below the target range with low pulmonary blood flow (Qp) compared to variable FIO2 group. The increase in PaO2 and Qp with variable FIO2 resuscitation was similar to control lambs. Conclusion:Maintaining SpO2 as recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and higher Qp in asphyxiated lambs with lung disease. Our findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.

AB - Background:The Neonatal Resuscitation Program (NRP) recommends upper and lower limits of preductal saturations (SpO 2) extrapolated from studies in infants resuscitated in room air. These limits have not been validated in asphyxia and lung disease.Methods:Seven control term lambs delivered by cesarean section were ventilated with 21% O 2. Thirty lambs with asphyxia with meconium aspiration were randomly assigned to resuscitation with 21% O2 (n = 6), 100% O2 (n = 6), or initiation with 21% O2 followed by variable FIO2 to maintain NRP target SpO2 ranges (n = 18). Hemodynamic and ventilation parameters were recorded for 15 min.Results:Control lambs maintained preductal SpO2 near the lower limit of NRP target range. Asphyxiated lambs had low SpO2 (38 ± 2%), low arterial pH (6.99 ± 0.01), and high PaCO2 (96 ± 7 mm Hg) at birth. Resuscitation with 21% O2 resulted in SpO2 values below the target range with low pulmonary blood flow (Qp) compared to variable FIO2 group. The increase in PaO2 and Qp with variable FIO2 resuscitation was similar to control lambs. Conclusion:Maintaining SpO2 as recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and higher Qp in asphyxiated lambs with lung disease. Our findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.

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