van Leuteren Ruud W, Scholten Anouk W J, Dekker Janneke, Martherus Tessa, de Jongh Frans H, van Kaam Anton H, Te Pas Arjan B, Hutten Jeroen
Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands.
Front Pediatr. 2021 Feb 9;9:640491. doi: 10.3389/fped.2021.640491. eCollection 2021.
The initial FiO that should be used for the stabilization of preterm infants in the delivery room (DR) is still a matter of debate as both hypoxia and hyperoxia should be prevented. A recent randomized controlled trial showed that preterm infants [gestational age (GA) < 30 weeks] stabilized with an initial high FiO (1.0) had a significantly higher breathing effort than infants stabilized with a low FiO (0.3). As the diaphragm is the main respiratory muscle in these infants, we aimed to describe the effects of the initial FiO on diaphragm activity. In a subgroup of infants from the original bi-center randomized controlled trial diaphragm activity was measured with transcutaneous electromyography of the diaphragm (dEMG), using three skin electrodes that were placed directly after birth. Diaphragm activity was compared in the first 5 min after birth. From the dEMG respiratory waveform several outcome measures were determined for comparison of the groups: average peak- and tonic inspiratory activity (dEMG and dEMG, respectively), inspiratory amplitude (dEMG), area under the curve (dEMG) and the respiratory rate (RR). Thirty-one infants were included in this subgroup, of which 29 could be analyzed [ = 15 (median GA 28.4 weeks) and = 14 (median GA 27.9 weeks) for the 100 and 30% oxygen group, respectively]. Tonic diaphragm activity was significantly higher in the high FiO-group (4.3 ± 2.1 μV vs. 2.9 ± 1.1 μV; = 0.047). The other dEMG-parameters (dEMG, dEMG, dEMG) showed consistently higher values in the high FiO group, but did not reach statistical significance. Average RR showed similar values in both groups (34 ± 9 vs. 32 ± 10 breaths/min for the high and low oxygen group, respectively). Preterm infants stabilized with an initial high FiO showed significantly more tonic diaphragm activity and an overall trend toward a higher level of diaphragm activity than those stabilized with an initial low FiO. These results confirm that a high initial FiO after birth stimulates breathing effort, which can be objectified with dEMG.
在产房（DR）中，用于稳定早产儿状况的初始吸入氧分数（FiO）仍是一个有争议的问题，因为既要防止低氧血症又要防止高氧血症。最近一项随机对照试验表明，初始高FiO（1.0）稳定病情的早产儿[胎龄（GA）<30周]比初始低FiO（0.3）稳定病情的婴儿呼吸努力明显更高。由于膈肌是这些婴儿的主要呼吸肌，我们旨在描述初始FiO对膈肌活动的影响。在原双中心随机对照试验的一个婴儿亚组中，出生后立即使用三个皮肤电极通过膈肌经皮肌电图（dEMG）测量膈肌活动。比较出生后最初5分钟内的膈肌活动。从dEMG呼吸波形中确定了几个结局指标用于组间比较：平均峰值吸气活动和紧张性吸气活动（分别为dEMG和dEMG）、吸气幅度（dEMG）、曲线下面积（dEMG）和呼吸频率（RR）。该亚组纳入了31名婴儿，其中29名可进行分析[100%氧组和30%氧组分别为n = 15（中位GA 28.4周）和n = 14（中位GA 27.9周）]。高FiO组的紧张性膈肌活动明显更高（4.3±2.1μV对2.9±1.1μV；P = 0.047）。其他dEMG参数（dEMG、dEMG、dEMG）在高FiO组中始终显示出更高的值，但未达到统计学意义。两组的平均RR值相似（高氧组和低氧组分别为34±9次/分钟和32±10次/分钟）。与初始低FiO稳定病情的早产儿相比，初始高FiO稳定病情的早产儿紧张性膈肌活动明显更多，且膈肌活动水平总体呈升高趋势。这些结果证实，出生后初始高FiO会刺激呼吸努力，这可以通过dEMG客观化。
