Abstract 14185: Targeting Lower Oxygen Saturation Parameters in Premature Infants Does Not Increase Incidence of Pulmonary Hypertension in the Neonatal Intensive Care Unit

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maria Niccum ◽  
Fotios Spyropoulos ◽  
Jonathan Levin ◽  
Carter Petty ◽  
Mary P Mullen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Birth Weight ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Positive Association ◽  
Increased Risk ◽  
Significant Difference ◽  
Lower Oxygen

Introduction: Lower oxygen saturation targets in preterm infants have been associated with decreased incidence of bronchopulmonary dysplasia (BPD) but increased risk of pulmonary hypertension (PH). Studies have shown that targets of <90% are associated with higher incidence of PH, however data on the optimal saturation target >90% are lacking. In this study, we compared the rate of BPD and PH in two cohorts with saturation targets of 94-98% and 92-97%. We hypothesized that BPD rate would be lower and PH rate would be unchanged at the lower saturation target. Methods: We performed a retrospective cohort study comparing PH and BPD rates among two cohorts of infants born at ≤32 weeks gestation at Brigham and Women’s Hospital: cohort 1 with saturation target of 94-98% (n = 129, July 2017-July 2018), cohort 2 with saturation target of 92-97% (n = 124, July 2018-July 2019). PH was defined by echocardiographic evidence of systolic septal flattening or right ventricular pressure ≥35 mmHg (estimated by tricuspid regurgitant jet velocity or shunt velocity) at gestational age (GA) ≥36 weeks. Comparisons between groups were carried out by Chi-square test, t-test, and multivariable logistic regression. Results: Subjects had a GA of 23-32 weeks; 46% were female. Groups did not differ with respect to GA, sex, or birth weight. There was no difference in rate of PH (2.4% vs. 4.2%, p = 0.12) or BPD (25% vs. 20%, p = 0.31) between cohort 1 and cohort 2. Other clinical parameters were not different between groups, including presence of patent ductus arteriosus, presence of atrial septal defect, use of diuretics, or use of steroids. After controlling for GA, birth weight, sex, and diagnosis of BPD using logistic regression, there was no difference in rate of PH between groups (p = 0.47), but there was a positive association of BPD with PH (OR 3.45; 95% CI, 1.18-10.09; p = 0.02). Conclusions: A lower oxygen saturation target was not associated with a higher rate of PH or lower rate of BPD in preterm infants. The overall rate of PH was much lower than rates previously reported at saturation targets <90%. Given our low incidence of PH, and the lack of a significant difference in rate of PH between groups, a saturation target of 92-97% may be safe while also minimizing need for supplemental oxygen in this population.

Lower oxygen saturation targets in preterm infants are not associated with increased rates of pulmonary hypertension

2021 ◽  
pp. 1-8
Author(s):  
M. Niccum ◽  
F. Spyropoulos ◽  
J.C. Levin ◽  
C.R. Petty ◽  
M.P. Mullen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Birth Weight ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Gestational Age ◽  
Retrospective Cohort ◽  
Chi Square ◽  
Average Birth Weight ◽  
Lower Oxygen ◽  
Chi Square Test

BACKGROUND: The optimal oxygen saturation target in preterm infants is not known. In this study, we aimed to assess the effect of lower oxygen saturation targets on the rate of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and pulmonary hypertension (PH) in preterm infants. METHODS: Retrospective cohort study comparing BPD, ROP, and PH incidence among two cohorts of infants born at≤32 weeks gestation with different oxygen saturation targets at≥34 weeks post-menstrual age (PMA): cohort 1, 94–98% (n = 126); cohort 2, 92–97% (n = 121). Groups compared by Chi-square test, t-test, and multivariable logistic regression. RESULTS: When comparing cohort 1 (average gestational age 29.8 weeks, average birth weight 1271g) with cohort 2 (average gestational age 29.6 weeks, average birth weight 1299g), there was no difference in rate of BPD (24% vs. 19%, p = 0.38), ROP (4% vs. 3%, p = 0.49), or PH (2% vs. 4%, p = 0.44). CONCLUSION: An oxygen saturation target of 92–97% at≥34 weeks PMA was not associated with a higher rate of PH or lower rate of BPD or ROP when compared with a higher target of 94–98%.

scholarly journals Correlation of Retinopathy of Prematurity with Oxygen Saturation

2021 ◽  
Vol 6 (06) ◽  
pp. 391-392
Author(s):  
Praveen S ◽  
Waris A
Keyword(s):  
Birth Weight ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Retinopathy Of Prematurity ◽  
Oxygen Therapy ◽  
Prolonged Exposure ◽  
Supplementary Oxygen ◽  
Childhood Blindness ◽  
Lower Oxygen ◽  
Proliferative Disease

Retinopathy of prematurity (ROP) is an abnormal vascular proliferative disease of retina that affects preterm infants. It is a leading cause of childhood blindness worldwide despite improvement in neonatal care and management. Earlier ROP was found to be associated with oxygen therapy only. Now it was concluded that aetiology of ROP was multifactorial but three factors have shown significant association with ROP: low gestational age (GA), low birth weight (BW), prolonged exposure to supplementary oxygen following delivery. Several investigators reported that lower oxygen saturation targets at young post-gestational ages with increased oxygen saturation targets at older post gestational ages reduced the incidence of ROP. However previous clinical studies are not conclusive.

scholarly journals Oxygen Saturation in Neonate after Birth

2022 ◽  
Vol 8 (1) ◽  
pp. 341-349
Author(s):  
Ajmery Sultana Chowdhury
Keyword(s):  
Heart Rate ◽  
Birth Weight ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Selection Criteria ◽  
Mode Of Delivery ◽  
High Positive Correlation ◽  
Significant Difference ◽  
Lower Spo2 ◽  
Birth Preterm

Background: Oxygen saturation measures the quantity of haemoglobin in the blood that is saturated with oxygen. Hemoglobin is a component of red blood cells that binds oxygen and transports it to outlying tissues. Oxygen is commonly used throughout the world in neonatal units. Injudicious use of Oxygen may not maintain appropriate oxygen status rather can lead to hypoxemia or hyperoxemia, both of the conditions are injurious to neonatal health. Objective: To assess the oxygen saturation in neonate after birth.Methods:A cross-sectional study conducted in the Department of Neonatology BSMMU, Shahbag, Dhaka, Lab Aid Specialized Hospital, Dhaka, Bangladesh from October 2013 to March 2014. A total 317 patients were selected according to selection criteria. The parents were interviewed with a specific pre-designed and pre-tested questionnaire and some information were gathered by document review. All neonate both term and late preterm (˃34weeks) who would not be anticipated for resuscitation was included.Results:A total 317 neonate were selected according to selection criteria. Among the study subjects more than half were male (57.1%). Rests were female (42.9%). Average gestational age of the study subjects was 37.47± 1.16 (SD) with the range of 34-40. On the other hand average birth weight was 2.88±0.46 (SD) with the minimum birth weight 2.0 kg and maximum weight 4.2 kg. Illustrates the median (IQR) heart rate from one to ten min for preterm versus term births. At one to three minutes and at five minutes after birth preterm infants had significantly lower SpO2 measurements. From six to 10 minutes after birth and four minutes after birth there was no significant difference between SpO2 measurements for mode of delivery. Paired sample t test showed that average SpO2 was less in 1 minute[88.42±4.8(SD)] than in 5 minute [94.25±3.5(SD)] and statistically this differences were highly significant (t=24.44, p=0.000). Pearson correlation showed high positive correlation (p=0.000) and correlation co-efficient r=0.479. Correlation was significant at the 0.01 level.Conclusion:It is “normal” to have low oxygen saturation measurements in the first minutes after birth. It takes time for infants to reach oxygen saturation levels described as “normal” in the later postnatal period. Oxygen saturation increased with time i.e., it was more in 5 minutes than in 1 minute and similarly more in 10 minutes than in 5 minutes. Conversely heart rate was found more in one minute than to five and ten minutes. Oxygen saturation was ≥ 90% within 3 to 4 minutes. Significant changes were found in Oxygen saturation by mode of delivery in three minutes & in heart rate by two minutes after birth. At one to ten minutes after birth preterm infants had lower SpO2 measurements.

scholarly journals Increased Risk of Stillbirth among Women whose Partner Has Tuberculosis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Qi Sun ◽  
Hongguang Zhang ◽  
Ya Zhang ◽  
Zuoqi Peng ◽  
Jianbo Lu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Pregnancy Outcomes ◽  
Chinese Women ◽  
Adverse Pregnancy Outcomes ◽  
Control Group ◽  
Increased Risk ◽  
Significant Difference ◽  
Adverse Pregnancy

Background. The relationship between tuberculosis (TB) and adverse pregnancy outcomes remains unclear. The aim of our study was to investigate whether TB is a risk factor for adverse pregnancy outcomes including premature birth, low birth weight, and stillbirth. Method. We conducted a population-based retrospective cohort study in mainland China. A total of 3,668,004 Chinese women, along with their partners, were included in this study, within the National Free Pre-Pregnancy Checkups Project, during 2015–2018. Propensity score matching was used to balance the two groups (cases: women or partners with TB; controls: women and partners without TB). Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results. Multivariate logistic regression showed that the OR of stillbirth for cases was 1.89 (95% CI: 1.09–3.16), in comparison with the control group. In the subgroup analysis, women whose partner had TB had a higher risk of stillbirth (OR: 2.13, 95% CI: 1.10–3.86) than women whose partner did not have TB. There was no significant difference in adverse pregnancy outcomes, including preterm birth, low birth weight, and stillbirth, between women with and without TB. Conclusions. Women whose partner had TB were more likely to have stillbirth than women whose partners did not have TB.

scholarly journals Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (7) ◽  
pp. 594
Author(s):  
Amy L. Lesneski ◽  
Payam Vali ◽  
Morgan E. Hardie ◽  
Satyan Lakshminrusimha ◽  
Deepika Sankaran
Keyword(s):  
Blood Flow ◽  
Pulmonary Hypertension ◽  
Oxygen Saturation ◽  
Ductus Arteriosus ◽  
Neonatal Resuscitation ◽  
Meconium Aspiration Syndrome ◽  
Ovine Model ◽  
Neurodevelopmental Outcomes ◽  
Meconium Aspiration ◽  
Blood Flows

Neonatal resuscitation (NRP) guidelines suggest targeting 85–95% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85–94%) and high (95–99%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85–94%) or high (95–99%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4–10.8) min) compared to standard SpO2 target (31.5 (21–66.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95–99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.

scholarly journals Neonatal and Postneonatal Pulmonary Hypertension

Children ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. 131
Author(s):  
Satyan Lakshminrusimha
Keyword(s):  
Pulmonary Hypertension ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Right Ventricular Dysfunction ◽  
Fold Increase ◽  
Pulmonary Vein Stenosis ◽  
Term Infants ◽  
Pulmonary Vasodilators ◽  
Non Invasive Ventilation ◽  
Early Closure

During transition at birth with ventilation of the lungs, pulmonary vascular resistance (PVR) decreases from high fetal values, leading to an 8 to 10-fold increase in pulmonary blood flow (Qp). In some infants, this transition does not occur, resulting in pulmonary hypertension (PH). In infants, PH can present as: (a) primary PH in term neonates (idiopathic), (b) PH secondary to lung disease or hypoplasia in term infants, (c) acute PH in preterm infants with respiratory distress syndrome (RDS), (d) chronic PH with bronchopulmonary dysplasia (BPD) in preterm infants and (e) post-neonatal PH. A hemodynamically significant patent ductus arteriosus (PDA) can exacerbate PH in preterm infants due to increased Qp. Pulmonary vein stenosis (PVS) can complicate BPD with PH. Diagnosis of PH is based on clinical features, echocardiography and, in some intractable cases, cardiac catheterization. Therapy of PH includes oxygen, invasive or non-invasive ventilation, correction of acidosis, surfactant and selective and non-selective pulmonary vasodilators such as inhaled nitric oxide and sildenafil, respectively. Early closure of a hemodynamically significant PDA has the potential to limit pulmonary vascular remodeling associated with BPD and PH. The role of thiamine in pathogenesis of PH is also discussed with the recent increase in thiamine-responsive acute pulmonary hypertension in early infancy. Recognition and prompt therapy of PH can prevent right ventricular dysfunction, uncoupling and failure.

scholarly journals The Management of Myelomeningocele Study: Short-Term Neonatal Outcomes

2020 ◽  
Vol 47 (12) ◽  
pp. 865-872 ◽  
Author(s):  
Natalie E. Rintoul ◽  
Roberta L. Keller ◽  
William F. Walsh ◽  
Pamela K. Burrows ◽  
Elizabeth A. Thom ◽  
...  
Keyword(s):  
New England ◽  
Gestational Age ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Outcome Data ◽  
Neonatal Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
The Impact ◽  
Prenatal Surgery

<b><i>Introduction:</i></b> The Management of Myelomeningocele Study was a multicenter randomized trial to compare prenatal and standard postnatal repair of myelomeningocele (MMC). Neonatal outcome data for 158 of the 183 randomized women were published in <i>The New England Journal of Medicine</i> in 2011. <b><i>Objective:</i></b> Neonatal outcomes for the complete trial cohort (<i>N</i> = 183) are presented outlining the similarities with the original report and describing the impact of gestational age as a mediator. <b><i>Methods:</i></b> Gestational age, neonatal characteristics at delivery, and outcomes including common complications of prematurity were assessed. <b><i>Results:</i></b> Analysis of the complete cohort confirmed the initial findings that prenatal surgery was associated with an increased risk for earlier gestational age at birth. Delivery occurred before 30 weeks of gestation in 11% of neonates that had fetal MMC repair. Adverse pulmonary sequelae were rare in the prenatal surgery group despite an increased rate of oligohydramnios. There was no significant difference in other complications of prematurity including patent ductus arteriosus, sepsis, necrotizing enterocolitis, periventricular leukomalacia, and intraventricular hemorrhage. <b><i>Conclusion:</i></b> The benefits of prenatal surgery outweigh the complications of prematurity.

scholarly journals Evaluation of neurodevelopment of preterm infants using Bayley III scale

2015 ◽  
Vol 15 (1) ◽  
pp. 47-55 ◽  
Author(s):  
Fernanda Veiga de Góes ◽  
Maria Dalva B. B. Méio ◽  
Rosane Reis de Mello ◽  
Denise Morsch
Keyword(s):  
Preterm Infants ◽  
Motor Development ◽  
High Frequency ◽  
Expressive Language ◽  
Cross Sectional Study ◽  
Receptive Language ◽  
Abnormal Development ◽  
Cross Sectional ◽  
Increased Risk ◽  
Significant Difference

Objectives: to assess cognitive, motor, and language development in preterm infants, and perinatal, neonatal and socioeconomic factors associated with abnormal development. Methods: a cross-sectional study was carried out with 104 preterm infants (gestational ages < 33 weeks) (17 - 30 months corrected ages) using the Bayley III Scale. Logistic regression analysis was performed and prevalence ratios calculated. Results: the average language score (81.9) was low, while cognitive (93.7) and motor (91.1) scores were within normal values. There were deficiencies in receptive but not in expressive language. Male sex (OR 2.55 CI 1.01-6.44) and neonatal pneumonia (OR 33.85 CI 3.3-337.8) were associated with abnormal language scores. No factor was associated with abnormal cognitive scores; male gender indicated an increased risk of abnormal motor scores. The lack of a father was a risk factor for impaired motor development (PR: 2.96, CI: 5.6 - 1.55). There was no statistically significant difference in the development of small and appropriate for gestational age children. Conclusions: the Bayley III Scale was useful for assessing language and cognition separately, discriminating between receptive and expressive language. There was a high frequency of language deficiencies, especially in receptive language. Although motor and cognitive average scores were within the normal range, there was a high frequency of children with delayed development in these areas, especially motor development.

scholarly journals MODE OF DELIVERY AND ITS IMPACT ON NEONATAL OUTCOMES IN PRETERM INFANTS

2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e27-e27
Author(s):  
Sarah McKnight ◽  
Bishal Gautam ◽  
Michael Miller ◽  
Bryan S Richardson ◽  
Orlando da Silva
Keyword(s):  
Caesarean Section ◽  
Preterm Infants ◽  
Periventricular Leukomalacia ◽  
Ductus Arteriosus ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Breech Presentation ◽  
Neonatal Outcomes ◽  
Care Hospital ◽  
Significant Difference

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.

scholarly journals ORAL VERSUS INTRAVENOUS IBUPROFEN FOR THE EARLY CLOSURE OF PATENT DUCTUS ARTERIOSUS IN LOW BIRTH WEIGHT PRETERM INFANTS

2013 ◽  
Vol 6 ◽  
Author(s):  
Alketa Hoxha ◽  
Ermira Kola ◽  
Numila Kuneshka ◽  
Eduard Tushe
Keyword(s):  
Birth Weight ◽  
Adverse Effects ◽  
Preterm Infants ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Ductal Closure ◽  
Oral Ibuprofen ◽  
Intravenous Ibuprofen ◽  
Ibuprofen Group ◽  
Patent Ductus

Background Patent ductus arteriosus (PDA) is common in very premature infants. Pharmacological closure of PDA with indomethacin, a prostaglandin inhibitor, has remained the mainstay of treatment in premature infants over the last three decades. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reaction in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route.This study was designed to assess the efficacy and safety of oral ibuprofen and intravenous ibuprofen for the early pharmacological treatment of PDA in LBW preterm infants with respiratory distress syndrome.MethodsA randomized, single-blinded, controlled study was performed on premature neonates at the neonatal care unit of the University Hospital for Obstetrics and Gynecology”Koco Gliozheni”, Tirana, Albania, from January 2010 to December 2012. The study enrolled 68 preterm infants with gestational age between 28-32 weeks, birth weight ≤ 2000 g, postnatal age 48-96 h, and had echocardiographically confirmed significant PDA. The preterm infants received either intravenous or oral ibuprofen randomly as an initial dose of 10 mg/kg, followed by 5 mg/kg at 24 and 48 h. After the first dose of treatment in both groups, echocardiographic evaluation was performed, to determine the need for a second or third dose. The rate of ductal closure, adverse effects, complications, and the patient’s clinical course were recorded.Results All patients were born after 28 until 32 weeks’ gestation. 36 patients were treated with oral ibuprofen and 32 with intravenous ibuprofen in this period. After the first course of the treatment, the PDA closed in 30 (83.3%) of the patients assigned to the oral ibuprofen group versus 23 (71.8%) of those enrolled in the intravenous ibuprofen group (p = 0.355). There was no difference between treatment groups in demographics or baseline renal function. In the evaluation of renal tolerance, none of the patients had oliguria. There were no significant differences with respect to complications during the stay.Conclusions In low birth weight infants, the rate of early ductal closure with oral ibuprofen is at least as good as with the intravenous route.  Oral ibuprofen is associated with fewer adverse effects

Sign in / Sign up

Export Citation Format

Share Document