Die Erstversorgung Frühgeborener: der Einfluss von Sauerstoff auf die postnatale Adaptation

by Sarah Maria Zipse
Doctoral thesis
Date of Examination:2024-08-22
Date of issue:2024-08-28
Advisor:Prof. Dr. Thomas Paul
Referee:PD Dr. Ivo F. Brandes
Referee:Prof. Dr. Thomas Meyer
Persistent Address: http://dx.doi.org/10.53846/goediss-10702

 

 

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Abstract

English

Objective To date the optimal initial amount of oxygen (FiO2) for resuscitation of preterm infants is still being discussed. Evidence of reduced mortality in term and near-term infants led to a dramatic reduction in the use of oxygen in newborn infants in the delivery room. In preterm infants the consequence of variable oxygen strategies on short- and long-term outcomes are unclear. Supplemental oxygen may be necessary during resuscitation of preterm newborns especially of low gestational age. The aim of this study was to evaluate the impact of oxygen on postnatal stabilization of preterm infants during perinatal resuscitation including measurement of respiratory effort. Study design In this prospective observational study resuscitation of preterm infants was recorded continuously using a respiratory function monitor. After initial resuscitation with room air, titration of supplemental oxygen was indicated whenever infant oxygen saturation (SpO2) lay below the 3rd Dawson SpO2 percentile at 5 minutes of age. SpO2, heart rate (HR), FiO2 and respiratory effort (respiratory rate (RR) and expiratory tidal volume (VTe)) were analyzed for the first 10 minutes of age and/or in comparison before and during/after oxygen titration. Results 40 preterm infants were included (mean (SD) gestational age 30.6 (2.8) weeks). Spontaneous breathing was established in 28 preterm infants during initial room-air resuscitation and SpO2 below 3rd Dawson percentile. Additional oxygen was administered after median (IQR) 305 (272-345) s at a SpO2 of 50 (31-57) %. After 457 (400-527) s at a SpO2 of 81 (76-86) % the study group achieved Stabilization. Until Stabilization the FiO2 was 33 (29-38) %. Respiratory parameters were largely constant before and during/after oxygen supplementation: RR 67 (55-81) /min to 69 (54-81) /min (p=0.957), VTe 3.5 (2.0-5.7) ml/kg to 4.4 (3.1-6.8) ml/kg (p=0.248). At the end of resuscitation in the delivery room 21 (52.5 %) preterm infants did not need any and 9 infants low FiO2 (≤30 %) supplementation. Conclusions Data suggests that a short and low FiO2 course of supplementation might be the decisive factor for permanent conversion of cardiopulmonary circulation during postnatal adaptation. This conversion from fetal to neonatal circulation was most likely caused by a shunt reversal through the ductus arteriosus and functional closure of the foramen ovale. Supplemental oxygen may thus be necessary during resuscitation of preterm newborns at least temporarily.
Keywords: Neonatology; preterm infant; resuscitation; initial oxygen level; oxygen; respiratory effort; respiratory function monitor
 
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