Department of Newborn Care, The Royal Hospital for Women.
School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
Curr Opin Pediatr. 2018 Apr;30(2):192-198. doi: 10.1097/MOP.0000000000000610.
To evaluate current evidence for the use of lower or higher oxygen strategies for preterm infant resuscitation RECENT FINDINGS: The equipoise for using higher fraction of inspired oxygen (FiO2) (>0.4) to initiate preterm infant respiratory stabilization has been lost. Recent meta-analyses of randomized controlled trials assessing outcomes after using higher (FiO2 ≥ 0.6) vs. lower (FiO2 ≤ 0.3) oxygen strategies to initiate preterm resuscitation shows no difference in the rates of death or major morbidities. However, not achieving pulse oximetry saturations of at least 80% by 5 min of age, whether it was due to iatrogenic oxygen insufficiency or poor infant pulmonary function, was associated with lower heart rates (mean difference -8.37, 95% confidence interval: -15.73, -1.01) and major intraventricular hemorrhage. There remains scarce neurodevelopmental data in this area and information about the impact of oxygen targeting strategies in low resourced areas. These knowledge gaps are research priorities that must be addressed in large, well designed randomized controlled trials.
Most clinicians now use lower oxygen strategies to initiate respiratory support for all infants, including preterm infants with significant lung disease. However, the impact of such strategies, particularly for neurodevelopmental outcomes and for lower resourced areas, remains uncertain and must be urgently addressed.
评估目前在早产儿复苏中使用较低或较高氧气策略的证据。
使用较高吸氧分数（FiO2>0.4）启动早产儿呼吸稳定的平衡已经失去。最近的荟萃分析随机对照试验评估了使用较高（FiO2≥0.6）与较低（FiO2≤0.3）氧气策略启动早产儿复苏后的结局，显示在死亡率或主要并发症发生率方面没有差异。然而，在 5 分钟龄时未达到至少 80%的脉搏血氧饱和度，无论是由于医源性氧不足还是婴儿肺功能差所致，与较低的心率（平均差异-8.37，95%置信区间：-15.73，-1.01）和主要脑室内出血有关。在这方面仍然缺乏神经发育数据，以及关于氧气靶向策略在资源匮乏地区的影响的信息。这些知识空白是必须在大型、精心设计的随机对照试验中解决的研究重点。
现在大多数临床医生使用较低的氧气策略来启动所有婴儿的呼吸支持，包括患有严重肺部疾病的早产儿。然而，这种策略的影响，特别是对神经发育结局和资源匮乏地区的影响，仍然不确定，必须紧急解决。
