Background: 

Extremely premature infants (ELBW) with gestational ages <= 28 weeks are still in a very early phase of lung development. This implies: (i) lack of surfactant; (ii) lack of antioxidant defences; (iii) difficulty in gas exchange. We have shown that it is possibly an adequate foetal to neonatal transition using low oxygen concentrations in the delivery room (DR) (1). However, we do not have "normality" standards to back up our medical interventions.

Aim: 

To evaluate the oxygen saturation in ELBW with gestational ages <= 28 weeks not needing resuscitation in the DR until stabilisation.

Methods: 

We monitored 10 healthy ELBW not needing active manipulation in the DR using Data Acquisition System with ad hoc software monitored oxygen saturation (SpO₂), heart rate (HR), video image and tidal volume during the first 30 min of life. Data were unloaded and analysed.

Results: 

Reliable readings in pre-ductal pulse oximetry were obtained at 8614 sec, and post-ductal readings at 11622 sec. At 5 min SpO2 was 7515% and at 10 min 8511%. At 15 min 918%. Both pre-and-post ductal SpO2 remained significantly different at 30 min after birth.

Conclusions: 

(1) Pre-ductal pulse oximetry is obtained earlier and is more reliable regarding brain oxygenation. 2) ELBW infants need 10 min to achieve SpO₂ similar to term newborn infants at 5 min. 3) The use of oxygen could cause hyper-oxygenation with deleterious consequences. 4) Normality saturation nomogram for this group of patients is needed.

References: 

Escrig R et al Pediatrics 2008.