Family Forum / Parenting / Children's Health / November 2009

This points the finger ..

Preterm Resuscitation With Low Oxygen Causes Less Oxidative
Stress, Inflammation, and Chronic Lung Disease
PEDIATRICS Vol. 124 No. 3 September 2009
Maximo Vento, PhD, MDa, Manuel Moro, MDb, Raquel Escrig, MDa,
Luis Arruza, MDb, Gema Villar, MDb, Isabel Izquierdo, MDa,
L. Jackson Roberts, II, MDc, Alessandro Arduini, PhDd,
Justo Javier Escobar, PhDd, Juan Sastre, PhDd and Miguel A. Asensi,
PhDd

a Division of Neonatology, University Hospital La Fe, Valencia, Spain
b Division of Neonatology, University Hospital San Carlos, Madrid,
Spain
c Department of Pharmacology, Vanderbilt University, Nashville,
Tennessee
d Department of Physiology, Faculty of Pharmacy, University of
Valencia, Valencia, Spain

OBJECTIVE:
The goal was to reduce adverse pulmonary adverse outcomes,
oxidative stress, and inflammation in neonates of 24 to 28
weeks of gestation initially resuscitated with fractions
of inspired oxygen of 30% or 90%.

METHODS:
Randomized assignment to receive 30% (N = 37) or 90% (N = 41)
oxygen was performed.
Targeted oxygen saturation values were 75% at 5 minutes and 85%
at 10 minutes.
Blood oxidized glutathione (GSSG)/reduced glutathione ratio
and urinary o-tyrosine, 8-oxo-dihydroxyguanosine, and
isoprostane levels, isofuran elimination, and plasma interleukin
8 and tumor necrosis factor  levels were determined.

RESULTS:
The low-oxygen group needed fewer days of oxygen supplementation
(6 vs 22 days; P < .01) and fewer days of mechanical ventilation
(13 vs 27 days; P < .01) and had a lower incidence of
bronchopulmonary dysplasia at discharge (15.4% vs 31.7%; P < .05).
GSSG/reduced glutathione x 100 ratios at day 1 and 3 were
significantly higher in the high-oxygen group (day 1: high-oxygen
group: 13.36 ± 5.25; low-oxygen group: 8.46 ± 3.87; P < .01; day 3:
high-oxygen group: 8.87 ± 4.40; low-oxygen group: 6.97 ± 3.11; P < .
05).
Urinary markers of oxidative stress were increased significantly in
the high-oxygen group, compared with the low-oxygen group, in the
first week after birth.
GSSG levels on day 3 and urinary isofuran, o-tyrosine, and
8-hydroxy-2'-deoxyguanosine levels on day 7 were correlated
significantly with development of chronic lung disease.

CONCLUSIONS:
Resuscitation of preterm neonates with 30% oxygen causes less
oxidative stress, inflammation, need for oxygen, and risk of
bronchopulmonary dysplasia.

Key Words: prematurity • resuscitation • oxygen • oxidative stress
biomarkers • inflammatory cytokines • bronchopulmonary dysplasia

Abbreviations: ELGAN—extremely low gestational age neonate •
DR—delivery room • BPD—bronchopulmonary dysplasia •
ROS—reactive oxygen species • FIO2—fraction of inspired oxygen •
SpO2—pulse oxygen saturation • GSH—reduced glutathione •
GSSG—oxidized glutathione • TNF-—tumor necrosis factor  •
IL-8—interleukin 8 • HR—heart rate

Accepted Apr 14, 2009.
Published online August 3, 2009
PEDIATRICS Vol. 124 No. 3 September 2009, pp. e439-e449
(doi:10.1542/peds.2009-0434)

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Tom

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