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  • Letter to the Editor
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Response to Drs Lanka and Cummings

Journal of Perinatology volume 30, pages 367–368 (2010)Cite this article

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We appreciate the interest shown in our paper and the comments of Lanka and Cummings.1 Resuscitation of the very low birth weight infant has become complex. In addition to monitoring supplemental oxygen delivery, close attention to temperature control, the most appropriate and effective method of inflating the lung, and deciding whether to use early surfactant in the delivery room are all part of the intense attention to detail required in the early minutes following delivery. It is within this framework that we embarked on our practice plan to lower the inspired oxygen in the delivery room. In the Methods section of our paper, we clearly delineated the practice plan and one of our goals, which was to achieve saturation values of between 85–95%. This is consistent with the current Neonatal Resuscitation Program textbook, which states that ‘if saturations are less than 85% and are not increasing, increase the oxygen concentration being delivered from the blender’.2 Lanka and Cummings comment that ‘a saturation goal of 85% at 3 min is rather high, particularly when measured post-ductally as in this study’. This is personal conjecture and is not based on any evidence that we are aware of. Lanka and Cummings comment further that ‘A pre-ductal SpO2 of 85% at 5 min, or 70% at 3 min, is consistent with normal transition, and has been recommended by others’. Although this is a correct statement, the references relate to term babies.3, 4 In this regard, in the results we state that ‘In general, saturation values increased slowly to the desired range of 85 to 95% over 5 to 10 min’. We refer Lanka and Cummings to the papers of Escrig5 and Wang6 that describe the saturation changes with time in relation to the changes in inspired oxygen delivered. Regarding the issue of the changing oxygen requirement in the delivery room, we stated “The admitting inspired oxygen concentration (FiO2) was lower than the initiating FiO2 in the delivery room in 16 (31%) infants; it remained the same in 12 (22%) infants and increased in 25 (47%) infants”. Individually these changes were not influenced by the starting FiO2 in the delivery room.

The decrease in pCO2 from 53±10 to 41±12 during the practice plan was unanticipated. We do not have available the inflating pressures that were delivered during resuscitation. However, we have now reanalyzed our data in response to this question, which may help address the concern of a pressure effect. Thus, for those infants who were intubated in the delivery room (n=28), the pCO2 declined from 51±13 to 42±13 (P=0.049) when comparing the first two with the last epochs of the practice plan. For the infants who were placed on CPAP (n=25), the pCO2 declined from 49±9 to 42±9.5 (P=0.03) when comparing the first two with the last epochs.

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References

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  2. Kattwinkel Editor American Academy of Pediatrics. Neonatal Resuscitation Textbook. 5th edn. 2006. pp 8–9.

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  7. Long W, Corbet A, Cotton R, Courtney S, McGuiness G, Walter D et al. A controlled trial of synthetic surfactant in infants weighing 1250 g or more with respiratory distress syndrome. N Engl J Med 1991; 325: 1696–1703.

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Authors and Affiliations

  1. Division of Newborn Medicine, Weill Cornell Medical College, New York, NY, USA

    A Stola, J Schulman & J Perlman

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  1. A Stola
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  2. J Schulman
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  3. J Perlman
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Correspondence to J Perlman.

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Stola, A., Schulman, J. & Perlman, J. Response to Drs Lanka and Cummings. J Perinatol 30, 367–368 (2010). https://doi.org/10.1038/jp.2010.29

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