Dear swedish netters:

I read a very interesting article in Pediatrics: Saugstad OD, Ramji S, Vento M. Oxygen for newborn resuscitation: how much is enough? Pediatrics. 2006 Aug;118(2):789-92. PMID: 16882835

Authors say that "... initiation of 40% has been recommended for the last 10 years (In Sweden)", Them believed it's safe, and also, them think that blenders should be installed in all other countries for use this concentration.

I also found that the bag and mask, could offer Oxygen concentration near 40%, without reservoir. (AHA-AAP cpr guidelines).

What do you think about this last approach?

Best Regards,

Carlos DELGADO

Pediatrician Neonatologist

Instituto Nacional de Salud del Niño

Lima PERU

Dear Carlos,

I have just read this commentary by Saugstad, it is highly recommended reading! Saugstad is one of the leading researchers on neonatal resuscitation and oxygen effects.

According to Saugstad and co-authors, there are sufficient data to conclude that 100% oxygen at resuscitation should generally be avoided. I also interpret their views that oxygen administration should be rather low at initiation of resuscitation, but increased at 90 seconds if the infant has not improved. They put forward the Swedish strategy (which has been 40%) as an example.

I think they have a point about the idea to reduce oxygen administration to the "lowest level needed as fast as possible". A blender is probably the best way to control oxygen administration. However, one may also consider alternative ways to achieve differentiated oxygen levels in simplier setups, such as

* bag/mask with room air

* bag/mask with oxygen connected but no reservior (approx 40%)

* bag/mask with reservoir (100%).

Background: Neonatal resuscitation and positive pressure ventilation.

Decision node: Oxygen concentration: 21%... 40% ... 100%

Question: which one is better, under what circumstances?

Carlos DELGADO

Pediatrician Neonatologist

Instituto Nacional de Salud del Niño

Lima PERU

dear colleagues..

best wishes, i'm here for the first time in your forum, i'm a neonatologist working in Palestine, Shifa Hospital...in our NICU..we still follow the recommendation to use 100% oxygen for rescusitation, but when i teach NRP course, i put a note that air or less oxygen may be used at start , but..still don't change your first practice of using 100% oxygen in rescusitation..thanks

we still follow the recommendation of AAP/NRP 2000 for using 100% oxygen in rescusitation ..that is in our NICU/ Palestine/ shifa Hospital

we still use the recommended 90-100% oxygen for neonatal resuscitation.

start with 21%, add oxygen if no response in 60 -90 sec

Difficult to answer the question, without more specifics. Resuscitate who?

Preemie where I assume some pulmonary insufficiency I use 40%, term NB with perinatal depression but presumably normal lungs I use RA.

There are enough data, I believe, to be on pretty solid ground with the term NB resuscitation. For preemies, we really don't know, hence the compromise.

Poll questions need to be very specific in order to get truly useful information.....

Cheers,

M. Keszler MD

Georgetown U.

In Switzerland, we are currently revising our recommendations and have decided to recommend a starting FiO2 of 40%; this was chosen for pragmatic reasons: if you have no blender available, bagging with an ambu bag without oxygen reservoir using an oxygen flow of 4l/Min will result in an FiO2 of approximately 40%, similarly providing oxygen at 4l/Min with a face mask with side holes will result in an FiO2 of approximately 40%. In addition, the use of pulse oxymetry is recommended to guide adjustment of the FiO2.

In Spain the Neonatal Resuscitation Working Group recomended to start with FiO2 30-35% and increase or decrease if cardiac rate is increasing or the baby goes OK. We recomended included in the delivery room : blender oxygen-air and and pulse oxymetry. But, is only bag and mask is able. 40% is OK.

we still follow the recommendation of AAP/NRP 2000 for using 100% oxygen in rescusitation ..that is in our NICU/ Palestine/ shifa Hospital

You can communicate with our unit in Mansoura,Egypt Dr. Thabet. We welcome u. We do the same thing like u.