Abstract
Background: Perinatal asphyxia is responsible for multiple organ damage which is increased upon re-oxygenation by the generation of an excess of oxygen free radicals. Proximal tubular damage and the subsequent acute renal failure are common complications of severe asphyxia. Thus, limiting the amount of oxygen supplied upon resuscitation seems an adequate approach to reduce oxidative stress-derived renal damage. We hypothesized that room-air resuscitated infants would exhibit diminished renal damage as shown by specific clinical and biochemical markers.
Methods: A prospective randomised clinical trial blinded for the gas source was performed in 39 asphyxiated term newborns. 17 were resuscitated with room air (RAR) and 22 with pure oxygen (OxR). Oxidative stress markers such as reduced and oxidized glutathione (GSH, GSSG), and superoxide dismutase activity (SOD) were determined at birth, and 24 and 48 hours thereafter. Diuresis, N-acetylglucosaminidase (NAG) in urine, creatinine, urea, beta 2 microglobulin and fractional excretion of sodium were determined at 24 and 48 hours of life. 20 non-asphyxiated babies acted as controls. Long-term follow up was completed at one month of postnatal age.
Results: As shown in the Table, asphyxiated neonates showed in general altered parameters of oxidative stress and renal damage as compared to normal controls. However, at 48 hours of postnatal age, pure oxygen resuscitated infants show higher degree of oxidized glutathione, a higher SOD activity, and NAG excretion in the urine was signficantly higher than in room-air resuscitated infants. Moreover, total blood GSSG correlated significantly with NAG in urine indicating that oxidative stress correlated with renal damage. Significant differences between RAR and OxR groups lasted at least 3 weeks.
Conclusions: Room-air resuscitated asphyxiated neonates show significantly lesser proximal tubular renal damage as compared to pure oxygen resuscitated infants in the acute phase of asphyxia. Thus, high oxygen concentrations should be cautiously used in the resuscitation of asphyxiated newborn infants.
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Vento, M., Sastre, J., Asensi, M. et al. 263 Asphyctic Renal Damage is Increased by The Use of Pure Oxygen Upon Resuscitation. Pediatr Res 56, 508 (2004). https://doi.org/10.1203/00006450-200409000-00286
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DOI: https://doi.org/10.1203/00006450-200409000-00286