Am J Perinatol 2023; 40(06): 630-637
DOI: 10.1055/s-0041-1730362
Original Article

Differential Alveolar and Systemic Oxygenation during Preterm Resuscitation with 100% Oxygen during Delayed Cord Clamping

1   Department of Pediatrics, University of California Davis, Sacramento, California
,
1   Department of Pediatrics, University of California Davis, Sacramento, California
,
Praveen Chandrasekharan
2   Department of Pediatrics, University at Buffalo, Buffalo, New York
,
Wade Rich
3   Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
,
Anup Katheria
3   Neonatal Research Institute, Sharp Mary Birch Hospital for Women and Newborns, San Diego, California
› Institutsangaben

Funding This study received financial support from Children's Miracle Network (PV) (grant numbers: HD072929 [S.L.], K12 HL138052 [P.C.], and R03HD096510 [P.C.]).
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Abstract

Objective Delayed cord clamping (DCC) and 21 to 30% O2 resuscitation is recommended for preterm infants but is commonly associated with low pulmonary blood flow (Qp) and hypoxia. 100% O2 supplementation during DCC for 60 seconds followed by 30% O2 may increase Qp and oxygen saturation (SpO2).

Study Design Preterm lambs (125–127 days of gestation) were resuscitated with 100% O2 with immediate cord clamping (ICC, n = 7) or ICC + 30% O2, and titrated to target SpO2 (n = 7) or DCC + 100% O2 for 60 seconds, which followed by cord clamping and 30% O2 titration (n = 7). Seven preterm (23–27 weeks of gestation) human infants received continuous positive airway pressure (CPAP) + 100% O2 for 60 seconds during DCC, cord clamping, and 30% O2 supplementation after cord clamping.

Results Preterm lambs in the ICC + 100% O2 group resulted in PaO2 (77 ± 25 mm Hg), SpO2 (77 ± 11%), and Qp (27 ± 9 mL/kg/min) at 60 seconds. ICC + 30% O2 led to low Qp (14 ± 3 mL/kg/min), low SpO2 (43 ± 26%), and PaO2 (19 ± 7 mm Hg). DCC + 100% O2 led to similar Qp (28 ± 6 mL/kg/min) as ICC + 100% O2 with lower PaO2. In human infants, DCC + CPAP with 100% O2 for 60 seconds, which followed by weaning to 30% resulted in SpO2 of 92 ± 11% with all infants >80% at 5 minutes with 100% survival without severe intraventricular hemorrhage.

Conclusion DCC + 100% O2 for 60 seconds increased Qp probably due to transient alveolar hyperoxia with systemic normoxia due to “dilution” by umbilical venous return. Larger translational and clinical studies are warranted to confirm these findings.

Key Points

  • Transient alveolar hyperoxia during delayed cord clamping can enhance pulmonary vasodilation.

  • Placental transfusion buffers systemic oxygen tension and limits hyperoxia.

  • Use of 100% oxygen for 60 seconds during DCC was associated with SpO2 ≥80% by 5 minutes.

Note

The clinical part of the study was approved by Sharp Mary Birch hospital IRB and consents were obtained from parents. Dr. Satyan Lakshminrusimha is a member of the Neonatal Resuscitation Program Steering Committee of the American Academy of Pediatrics (AAP). The opinions expressed in this manuscript are the author's own and does not reflect the official position of the AAP.


Authors' Contributions

S.L., A.K., P.V., P.K., and W.R. provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, and also supported in final approval of the version to be published. S.L., A.K., P.V., and P.K. supported in drafting the article or revising it critically for important intellectual content.




Publikationsverlauf

Eingereicht: 30. März 2021

Angenommen: 11. April 2021

Artikel online veröffentlicht:
01. Juni 2021

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