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Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia

Journal of Perinatology volume 38, pages 834–843 (2018)Cite this article

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Abstract

Objective:

To evaluate whether infants with congenital diaphragmatic hernia (CDH) can be safely resuscitated with a reduced starting fraction of inspired oxygen (FiO2) of 0.5.

Study design:

A retrospective cohort study comparing 68 patients resuscitated with starting FiO2 0.5 to 45 historical controls resuscitated with starting FiO2 1.0.

Results:

Reduced starting FiO2 had no adverse effect upon survival, duration of intubation, need for ECMO, duration of ECMO, or time to surgery. Furthermore, it produced no increase in complications, adverse neurological events, or neurodevelopmental delay. The need to subsequently increase FiO2 to 1.0 was associated with female sex, lower gestational age, liver up, lower lung volume–head circumference ratio, decreased survival, a higher incidence of ECMO, longer time to surgery, periventricular leukomalacia, and lower neurodevelopmental motor scores.

Conclusion:

Starting FiO2 0.5 may be safe for the resuscitation of CDH infants. The need to increase FiO2 to 1.0 during resuscitation is associated with worse outcomes.

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Acknowledgements

Research reported in this study was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award number TL1TR001880 for author JSR.

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Authors and Affiliations

  1. The Center for Fetal Diagnosis and Treatment, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    John S. Riley, Ryan M. Antiel, Natalie E. Rintoul, Anne M. Ades, Lindsay N. Waqar, Lisa M. Herkert, William H. Peranteau, Alan W. Flake, N. Scott Adzick & Holly L. Hedrick

  2. Division of Neurology, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Nan Lin

  3. Neonatal Follow-up Program, The Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Jo Ann D’Agostino & Casey Hoffman

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  1. John S. Riley
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Correspondence to Holly L. Hedrick.

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Riley, J.S., Antiel, R.M., Rintoul, N.E. et al. Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia. J Perinatol 38, 834–843 (2018). https://doi.org/10.1038/s41372-017-0031-5

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