Lesneski Amy L, Vali Payam, Hardie Morgan E, Lakshminrusimha Satyan, Sankaran Deepika
Department of Stem Cell Research, University of California, Davis, Sacramento, CA 95817, USA.
Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA.
Children (Basel). 2021 Jul 14;8(7):594. doi: 10.3390/children8070594.
Neonatal resuscitation (NRP) guidelines suggest targeting 85-95% preductal SpO by 10 min after birth. Optimal oxygen saturation (SpO) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (Q), carotid (Q)and ductal (Q) blood flows between standard (85-94%) and high (95-99%) SpO targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85-94%) or high (95-99%) SpO targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO target (7.4 (4.4-10.8) min) compared to standard SpO target (31.5 (21-66.2) min, = 0.03). Q was significantly higher during the first 10 min after birth with higher SpO target. At 60 min after birth, the Q, Q and Q were not different between the groups. To conclude, targeting SpO of 95-99% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase Q but no differences were observed at 60 min. Clinical studies comparing low and high SpO targets assessing hemodynamics and neurodevelopmental outcomes are warranted.
新生儿复苏（NRP）指南建议在出生后10分钟内将出生前导管血氧饱和度（SpO）目标设定为85%-95%。在新生儿胎粪吸入综合征（MAS）合并持续性肺动脉高压（PPHN）的复苏过程及复苏后管理中，最佳血氧饱和度（SpO）目标仍不确定。我们的目的是比较复苏期间及复苏后，标准（85%-94%）和高（95%-99%）SpO目标下，导管血流从胎儿型（右向左）转变为左向右的时间，并评估肺（Q）、颈动脉（Q）和导管（Q）的血流情况。通过气管内注入胎粪和阻断脐带使12只羔羊窒息以诱导MAS和PPHN，按照NRP指南进行复苏，并随机分为标准（85%-94%）或高（95%-99%）SpO目标组。在12只患有MAS和PPHN的羔羊中，每组6只被随机分配到标准和高SpO目标组。与标准SpO目标（31.5（21-66.2）分钟，P = 0.03）相比，高SpO目标组（7.4（4.4-10.8）分钟）使动脉导管血流方向从右向左转变为左向右的中位[四分位间距]时间显著缩短。出生后最初10分钟内，较高SpO目标组的Q显著更高。出生后60分钟时，两组之间的Q、Q和Q没有差异。总之，在复苏期间及复苏后将SpO目标设定为95%-99%可能会加速患有MAS和PPHN的羔羊导管血流的逆转，并使Q暂时增加，但在60分钟时未观察到差异。有必要进行比较低和高SpO目标以评估血流动力学和神经发育结局的临床研究。
