Maria Afolabi sobbed piteously,
gasping for air, as she cradled the tiny lifeless body
of her newborn Lula. Sadly, if Lula had been given air,
instead of 100% oxygen, when she was gasping
for breath, this story could have had a happy ending.
A report in the October 9 issue of The Lancet
found that one in 20 newborns needing resuscitation
would have lived instead of dying if the delivery team
used air instead of pure oxygen.
Current international guidelines
for the resuscitation of neonates with hypoxia call
for 100% oxygen, even though it has never actually been
demonstrated that it's good for newborn babies. There
are even indications that, far from increasing oxygenation
in the brain where it's most needed, 100% oxygen actually
reduces cerebral perfusion in infants, and continues
to slow cerebral blood flow long after the oxygen is
withdrawn. Moreover, a high concentration of oxygen
unleashes free radicals that lead to reperfusion injury
after asphyxia. In animal models, this method of resuscitation
has even been known to cause brain damage.
Surprisingly, none of the limited
studies that previously compared air to pure oxygen
found a statistically significant benefit from either
method in resuscitation — until now. By pooling
the results of five previous studies, a team of Australian,
British and German researchers appeared to have finally
proven that 100% oxygen is harmful for newborns.
The studies, conducted in developing
countries, included 1,302 babies. Two of the studies
masked the treatment from the assessors, by means of
a nurse who controlled the ventilation equipment from
a separate room. In the other three trials, the clinicians
who assessed the child's condition knew which gas was
being used.
All of the infants suffered from
apnea or gasping. The trials included preterm deliveries,
as well as children at high risk of pulmonary hypertension,
with meconium aspiration, fulminant sepsis or severe
asphyxia, though these groups were not analyzed separately.
Only one of the studies followed
patients beyond 28 days of life, but in the short term,
the results were unequivocal. "One death would be prevented
for every 20 babies resuscitated with air rather than
100% oxygen," concluded the authors.
This finding confirmed widespread
suspicions that many neonatal centres have already acted
upon. In fact, in a survey published this year in Acta
Paediatrica, 20 out of 40 centres questioned had
already abandoned 100% oxygen for some lower concentration.
Commenting on The Lancet
findings, pediatrician Dr Georg Hansmann of the Stanford
University School of Medicine made this suggestion:
"On the basis of the existing data, air can be the initial
gas used for the resuscitation of moderately depressed
newborn infants at or near term. Adjustable oxygen supply
(oxygen blenders) as backup on treatment failure with
air must be available at any time."
|
