Oxygen delivery using neonatal self-inflating bags without reservoirs

The quest for optimum oxygenation during newborn delivery room resuscitation: Is it the baby or is it us?

Achieving "normal oxygenation" in sick newborn infants requiring resuscitation is one of the most difficult and incompletely informed practices in neonatal care. Suboptimal oxygenation, whether too little or too much, has profound repercussions, including death. In the last two decades, clinicians have lost equipoise for the use of higher oxygen strategies due to concerns of hyperoxia but emerging evidence suggests that lower oxygen strategies may also be as detrimental, especially in infants with pulmonary pathologies such as those born at the cusp of viability. Practice at the coalface using rapidly evolving recommendations has also uncovered continuing complexities in the quest to achieve optimum oxygenation during the first critical minutes of life. There are adjustable factors, such as the practical impediments to acquiring knowledge, equipment and expertise as well as unadjustable factors, such as inherent infant pathology, that necessitates agile clinical manipulation to "first do no harm". This review will address the deficiencies in knowledge that currently impede our quest to determine the best and safest means to deliver oxygen to sick infants during the first critical minutes of life and suggest practical solutions for current practice while awaiting definitive evidence from large scale, well defined, randomized controlled studies.

Oxygen for the delivery room respiratory support of moderate-to-late preterm infants. An international survey of clinical practice from 21 countries

AIM

The aim of this study was to determine clinician opinion regarding oxygen management in moderate-late preterm resuscitation.

METHODS

An anonymous online questionnaire was distributed through email/social messaging platforms to neonatologists in 21 countries (October 2020-March 2021) via REDCap.

RESULTS

Of the 695 respondents, 69% had access to oxygen blenders and 90% had pulse oximeters. Respondents from high-income countries were more likely to have oxygen blenders than those from middle-income countries (72% vs. 66%). Most initiated respiratory support with FiO₂ 0.21 (43%) or 0.3 (36%) but only 45% titrated FiO₂ to target SpO₂ . Most (89%) considered heart rate as a more important indicator of response than SpO₂ . Almost all (96%) supported the need for well-designed trials to examine oxygenation in moderate-late preterm resuscitation.

CONCLUSION

Most clinicians resuscitated moderate-late preterm infants with lower initial FiO₂ but some cannot/will not target SpO₂ or titrate FiO₂ . Most consider heart rate as a more important indicator of infant response than SpO₂ .Large and robust clinical trials examining oxygen use for moderate-late preterm resuscitation, including long-term neurodevelopmental outcomes, are supported amongst clinicians.

Summary of Japanese Neonatal Cardiopulmonary Resuscitation Guidelines 2015

The Japan Resuscitation Council joined the International Liaison Committee on Resuscitation (ILCOR) as a member of the Resuscitation Council of Asia in 2006. In 2007, the Japan Society of Perinatal and Neonatal Medicine (JSPNM), which is a member of an affiliated body, launched the Neonatal Cardiopulmonary Resuscitation (NCPR) program as an authorized project to ensure that all staff involved in perinatal and neonatal medicine can learn and practice neonatal cardiopulmonary resuscitation based on the Consensus on Science with Treatment Recommendations developed by ILCOR. The content of courses in the NCPR program is based on the NCPR guidelines. These guidelines are revised by the Japan Resuscitation Council according to the Consensus on Science with Treatment Recommendations, which is updated by ILCOR every 5 years. The latest updated edition in Japanese was published in 2016 and we translated these Japanese guidelines to English in 2018. Here, we introduce a summary of the NCPR guidelines 2015 in Japan. The NCPR 2015 algorithm has two flows, "lifesaving flow" and "stabilization of breathing flow" at the first branching point after the initial step of resuscitation.