Objectives Extremely low birth weight (ELBW) infants are prone to oxidative stress in spite of receiving prenatal corticosteroids.1 Oxygen free radicals trigger lung inflammation through activation of nuclear factor kappa B.
Hypothesis Reducing the oxygen load would allow effective resuscitation and reduce oxidative stress/damage.
Methods Prospective clinical trial assigning 24 ELBW randomly to high initial Fio2 (0.9; HOX) and 28 to low initial Fio2 (0.3; LOX). Spo2/heart rate (HR) were continuously monitored during resuscitation. Fio2 was adjusted to HR and Spo2. Blood samples were obtained from cord and venous blood at 24 and 72 h. Urine was collected at days 1, 3 and 7. GSH/GSSG determined by high-performance liquid chromatography; isoprostanes and isofurans by gas chromatography/MS/MS.
Results Both groups attained Spo2 85% and HR >100 bpm at 10–15 minutes postnatally. No differences regarding survival or immediate complications were detected. LOX babies received significantly lower oxygen load (HOX 864 ± 176 vs LOX 465 ± 104 ml O2/kg; p<0.01). Markers of oxidative stress and oxidative damage are shown in the table.
Conclusions It is safe to initiate the resuscitiation of ELBW with lower Fio2; it reduces oxygen load administered; it reduces oxidative stress and damage. The effect upon bronchopulmonary dysplasia will be reported when the trial is finished.