Use of Blended Oxygen for Delivery Room Resuscitation of VLBW Infants
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 40
- 试验地点
- 2
- 主要终点
- total antioxidant status
研究概览
简要总结
We propose a preliminary trial to evaluate the safety and efficacy of using more restricted oxygen during resuscitation for VLBW infants than is utilized currently in an effort to reduce the oxidant stress of such treatment, and to possibly reduce associated multi-system organ related dysfunction.
In attempting to design a trial comparing higher versus lower oxygen during neonatal resuscitation with the potential for benefit to the enrolled infants, and a minimal level of risk, and acknowledging that the use of Room Air may be considered premature in view of the lack of any safety data in this population, we are proposing to utilize an oxygen blender and a pulse oximeter in the delivery room in the treated group. The treated group will have their fraction of inspired oxygen increased from 21%, as necessary, to achieve a target oxygen saturation of 85 to 90% at 5 minutes of life, compared with the standard of care group who will receive 100% oxygen without the use of a blender, which is the current approach in most centers in this country. The targeted saturation of 85% will provide enough oxygen to treat any ventilation/perfusion mismatch, while exposing the infants to significantly less inspired oxygen.
Hypothesis: We hypothesize that the use of restricted inspired oxygen during resuscitation will result in a significant reduction in oxidant stress without any harmful clinical effects.
详细描述
We propose to study the preterm infant (gestational age 23-32 weeks) as these infants are the most vulnerable to the acute and chronic possible toxicities of excess oxygen and the associated oxygen free radicals. We will study 40 infants.
Infants will be randomized following parental consent obtained prior to delivery to initially be placed on a pulse oximeter and receive blended oxygen to a targeted oxygen saturation of 85 to 90% at 5 minutes of life, or 100% oxygen for a minimum of 5 minutes without the use of a blender. The inspired oxygen will be increased using the blender if the infant's SaO2 remains less than 60% at two minutes, less than 70% at 3 minutes, and/or if bradycardia with a heart rate of less than 100 bpm persists after 2 minutes of resuscitation.
Cord blood will be obtained following our usual procedures and a portion will be saved for later analysis of lipid peroxides, oxidized and reduced glutathione and total antioxidant status. Similar assays will be performed at 1 hour, week and at 1 month for all surviving infants.
Intervention:
Prior to the infant's delivery, the randomization will be drawn from double sealed envelopes randomized by blocks of 10. A blender will be in place in the delivery room area and provide the source of oxygen to the resuscitation device. Following randomization and before the delivery, the blender will be turned to either 21% or 100%. The respiratory therapist will increase the blender immediately to 100% oxygen under the following conditions:
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 23 Weeks 至 32 Weeks（Child）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •inborn infant
- •gestation 23 weeks to 31 weeks 6 days
排除标准
- •known chromosomal or congenital anomalies
结局指标
主要结局
total antioxidant status
oxygen saturations
lipid peroxide levels
次要结局
- Patent ductus arteriosus
- Periventricular leukomalacia
- Days on nasal canula
- Days on oxygen
- Days on conventional ventilation
- Days on high frequency ventilation
- Pneumothorax
- Necrotizing Enterocolitis
- Isolated gastrointestinal perforation
- Retinopathy
- Oxygen requirement at 36 weeks adjusted age
- Death
- Patent ductus arteriosus requiring ligation
- Surgery for necrotizing enterocolitis
- Intracranial hemorrhage
研究者
Neil Finer
Professor
University of California, San Diego