TY - JOUR
T1 - The Effect of Initial Oxygen Exposure on Diaphragm Activity in Preterm Infants at Birth
AU - van Leuteren, Ruud W.
AU - Scholten, Anouk W. J.
AU - Dekker, Janneke
AU - Martherus, Tessa
AU - de Jongh, Frans H.
AU - van Kaam, Anton H.
AU - te Pas, Arjan B.
AU - Hutten, Gerard J.
N1 - Funding Information: Funding. AP was recipient of an NWO innovational research incentives scheme (VIDI 91716428). Publisher Copyright: © Copyright © 2021 van Leuteren, Scholten, Dekker, Martherus, de Jongh, van Kaam, te Pas and Hutten. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2/9
Y1 - 2021/2/9
N2 - 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. 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 μV vs. 2.9 ± 1.1 μV; 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.
AB - 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. 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 μV vs. 2.9 ± 1.1 μV; 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.
KW - breathing effort
KW - delivery room
KW - diaphragm activity
KW - oxygen
KW - preterm infant
UR - http://www.scopus.com/inward/record.url?scp=85101207581&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/fped.2021.640491
DO - https://doi.org/10.3389/fped.2021.640491
M3 - Article
C2 - 33634059
SN - 2296-2360
VL - 9
JO - Frontiers in pediatrics
JF - Frontiers in pediatrics
M1 - 640491
ER -