Saugstad Ola Didrik
Department of Pediatrics, Rikshospitalet Medical Center, Faculty of Medicine, University of Oslo, Oslo, Norway.
Neonatology. 2007;91(4):319-22. doi: 10.1159/000101349. Epub 2007 Jun 7.
In recent years it has become clear that even a brief exposure to high oxygen concentration at birth and an oxygen saturation (SaO(2)) >93-95% in extremely low birth weight (ELBW) infants is more toxic than previously believed.
To summarize and review clinical studies published to date either dealing with resuscitation of newborn infants with different oxygen concentrations or the use of high or low SaO(2) in the neonatal period of ELBW infants.
Three systematic reviews of five trials and seven individual studies including up to 2,011 newborn infants have shown that neonatal mortality is reduced by 30-40% if resuscitation is carried out with 21% instead of 100% O(2). Room air resuscitation also leads to faster early recovery and need for shorter duration of resuscitation. Six studies of ELBW infants have shown that retinopathy of prematurity and chronic lung disease are significantly reduced if SaO(2) is kept <93-95% compared with higher saturations. Avoidance of fluctuations in SaO(2) also seems to be important. Two observational studies suggest a significant 2.5- to 3.5-fold increased risk of childhood cancer in infants resuscitated with 100% O(2) for a few minutes.
To date there are sufficient data available to recommend that newborn resuscitation should not be carried out with 100% O(2). In ELBW infants, SaO(2) levels should be kept between 85 and 93% or possibly between 88 and 95%, but should definitely not exceed 95%. Fluctuations should be avoided.
近年来已明确，即使是出生时短暂暴露于高氧浓度环境，以及极低出生体重（ELBW）婴儿的氧饱和度（SaO₂）>93 - 95%，其毒性比之前认为的更大。
总结和回顾迄今发表的临床研究，这些研究涉及不同氧浓度用于新生儿复苏，或ELBW婴儿新生儿期高或低SaO₂的使用情况。
对五项试验和七项个体研究的三项系统评价纳入了多达2011名新生儿，结果显示，如果用21%的氧气而非100%的氧气进行复苏，新生儿死亡率可降低30 - 40%。空气复苏还能使早期恢复更快，复苏持续时间更短。六项针对ELBW婴儿的研究表明，与较高饱和度相比，如果将SaO₂保持在<93 - 95%，早产儿视网膜病变和慢性肺病会显著减少。避免SaO₂波动似乎也很重要。两项观察性研究表明，用100%氧气复苏几分钟的婴儿患儿童癌症的风险显著增加2.5至3.5倍。
迄今为止，有足够的数据建议新生儿复苏不应使用100%的氧气。对于ELBW婴儿，SaO₂水平应保持在85%至93%之间，或者可能在88%至95%之间，但绝对不应超过95%。应避免波动。
