Background: The initial FiO(2) that should be used for the stabilization of preterm infants in the delivery room (DR) is still a matter of debate as both hypoxia and hyperoxia should be prevented.... Show moreBackground: The initial FiO(2) that should be used for the stabilization of preterm infants in the delivery room (DR) is still a matter of debate as both hypoxia and hyperoxia should be prevented. A recent randomized controlled trial showed that preterm infants [gestational age (GA) < 30 weeks] stabilized with an initial high FiO(2) (1.0) had a significantly higher breathing effort than infants stabilized with a low FiO(2) (0.3). As the diaphragm is the main respiratory muscle in these infants, we aimed to describe the effects of the initial FiO(2) on diaphragm activity.Methods: In a subgroup of infants from the original bi-center randomized controlled trial diaphragm activity was measured with transcutaneous electromyography of the diaphragm (dEMG), using three skin electrodes that were placed directly after birth. Diaphragm activity was compared in the first 5 min after birth. From the dEMG respiratory waveform several outcome measures were determined for comparison of the groups: average peak- and tonic inspiratory activity (dEMG(peak) and dEMG(ton), respectively), inspiratory amplitude (dEMG(amp)), area under the curve (dEMG(AUC)) and the respiratory rate (RR).Results: Thirty-one infants were included in this subgroup, of which 29 could be analyzed [n = 15 (median GA 28.4 weeks) and n = 14 (median GA 27.9 weeks) for the 100 and 30% oxygen group, respectively]. Tonic diaphragm activity was significantly higher in the high FiO(2)-group (4.3 +/- 2.1 mu V vs. 2.9 +/- 1.1 mu V; p = 0.047). The other dEMG-parameters (dEMG(peak), dEMG(amp), dEMG(AUC)) showed consistently higher values in the high FiO(2) group, but did not reach statistical significance. Average RR showed similar values in both groups (34 +/- 9 vs. 32 +/- 10 breaths/min for the high and low oxygen group, respectively).Conclusion: Preterm infants stabilized with an initial high FiO(2) showed significantly more tonic diaphragm activity and an overall trend toward a higher level of diaphragm activity than those stabilized with an initial low FiO(2). These results confirm that a high initial FiO(2) after birth stimulates breathing effort, which can be objectified with dEMG. Show less
Objective: To describe the effect of umbilical catheterization (UC) on skin temperature and cardiorespiratory status in preterm infants.Materials and methods: In a prospective observational study... Show moreObjective: To describe the effect of umbilical catheterization (UC) on skin temperature and cardiorespiratory status in preterm infants.Materials and methods: In a prospective observational study of infants <32 weeks of gestation, the duration of UC, course of skin temperature, and cardiorespiratory status were registered. Hypothermia was defined as a temperature below 36.5C.Results: UC was performed in 55 infants with a median (range) gestational age of 28 weeks (24-31) and birth weight of 1120g (625-2091). Mean (SD) temperature first decreased 0.6 (0.6)degrees C during UC followed by a rise of 0.4 (0.4)degrees C after reaching the minimal temperature. Hypothermia already existed in 69% (38/55) of the infants before start of UC, which increased to 89% (49/55) during UC (p = .001). Duration of UC was not associated with the development of hypothermia during the procedure (p = .48). Heart rate (mean(SD)) significantly increased (162 (17) versus 152 (15); p <.001) and there was a trend toward an increase in supplemental oxygen (mean(SD)) (0.31 (0.17) versus 0.28 (0.13); p = .78), but both changes were only temporary.Conclusion: Hypothermia was frequent in preterm infants before start of UC and increased during UC. Postponing UC until the infant has a normal temperature should be considered. Show less
Dekker, J.; Martherus, T.; Lopriore, E.; Giera, M.; McGillick, E.V.; Hutten, J.; ... ; Pas, A.B. te 2019
