NRP 2006: The Canadian Context Therapeutic Use of Oxygen (In Newborn Resuscitation) D.D. McMillan,MD November 17, 2006 Half of what we know today will be shown not to be true within 10 years But which half! “New” Equipment- NRP 2006 Blended oxygen Pulse oximeter
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NRP 2006: The Canadian ContextTherapeutic Use of Oxygen(In Newborn Resuscitation)
November 17, 2006
Half of what we know today
will be shown not to be true
within 10 years
But which half!
Air (L/Min) O2(L/Min) O2 Concentration(%)
5 0 21
4 1 37
3 2 53
2 3 68
1 4 84
0 5 100
What is the Evidence to Support
Room Air over 100% Oxygen
for Newborn Resuscitation?
Kaplan-Meier plot showing the proportion that had not taken the first breath in room air- and oxygen-resuscitated newborn infants. Time to first breath was significantly longer in the oxygen-resuscitated group compared with the room air-resuscitated group. In the oxygen group, 60/313 (19.2%) required >3 minutes to take the first breath compared with 28/284 (9.9%) in the room air group (OR = 0.47; 95% CI = 0.29-0.76).
Mortality with Oxygen or Air for Resuscitation- Saugstad, 2005
Collins Ped Res, 2001
- Increased CNS amino acids (eg.glutamate)
- Increased oxygen delivery to brain
(No change in glutamate)
- Lower mean BP & CNS microcirculation
(No change in CNS amino acids)
Does it have to be “all or none”?
Can we titrate oxygen to meet the “needs” of the newborn baby?
-77% Oxygen to start
-68% Use pulse oximeters to adjust
(58% flow-inf, 19% self-inf, 16% T-piece)