Critical Appraisal Journal Reading

Oxygen Therapy in Neonates

Jou

rnal R

ead

ing

Frandi Wirajaya, S.Ked (04111401019)

Retno Tharra, S.Ked (04111401029)

Sellita Seplana, S.Ked (04111001054)

Pembimbing:

dr. Indrayadi, Sp.A

• In 2000, international guidelines recommended that 100% oxygen should be used if assisted ventilation is required.

• The 2005 guidelines still recommend the use of supplemental oxygen (the specific concentration is unknown)

• Previous studies showed that room air may be as efficient as 100% oxygen for resuscitation of newborn infants and may be associated with quicker recovery, lower mortality rates, and lower risk for oxidative stress

Introduction

Although most Swedish hospitals changed their routines in 1997 to initiate resuscitation with 40% oxygen, a few hospitals, including 2 of the 7 level III perinatal centers in Sweden, continued to use 100% oxygen.

Introduction

The aim of the present study was to investigate whether resuscitation strategies using 40% and 100% oxygen are associated with differences in APGAR Score recovery.

PurposePurpose

Data :•Swedish Medical Birth Register (MBR) of 4 Swedish. •Infants were born from 1998 to 2003.•Two centers (A1 & A2) used 100% oxygen for resuscitation and two others (B1 & B2) used 40% oxygen for initial resuscitation•Included in the study were data for live-born, singleton, term infants (gestational age of 37 weeks) with birth weight appropriate for gestational age and with 1-minute Apgar scores of 4.•Infants with major malformation diagnoses were excluded

MethodsMethods

• Apgar score changes were analyzed by using both nonparametric and parametric tests; both medians and means are presented.

• The difference between the strategies regarding the Apgar score increases from 1 to 10 minutes was evaluated by using mixed-effect models for repeated-measurement data

• The differences in mortality and morbidity rates were analyzed by using multivariate logistic regression models

MethodsMethods

ResultResult

ResultResult

ResultResult

In the current population-based study, severely depressed infants who were born in centers using a 40% oxygen resuscitation strategy had a larger increase in Apgar scores from 1 to 5 minutes, compared with infants born in centers using 100% oxygen, but no significant difference in mean Apgar scores remained at 10 minutes.These findings agree with previous studies and a recent meta-analysis comparing resuscitation with room air versus 100% oxygen.

DiscussionDiscussion

The difference in mean Apgar scores between hospitals is 0.4.Infants born in hospitals using 100% oxygen had a 50% increased risk of having a 5-minute Apgar score of <7, compared with infants born in hospitals using 40% oxygen for resuscitation.Previous studies showed that term infants with 5-minute Apgar scores of 4 to 6 have considerably increased risk of death (relative risk: 45–53) and cerebral palsy (relative risk: 31), compared with infants with 5-minute Apgar scores of 7.

DiscussionDiscussion

The present data indicate that a resuscitation strategy based on administration of 40% oxygen is as efficient as one using 100% oxygen.

ConclusionConclusion

PICO VIA PICO VIA

The infants that were born from 1998 to 2003 at Swedish academic perinatal centers. The 4 perinatal units are referral centers for high-risk pregnancies, with level III NICUs.

Patient/Problem/Patient/Problem/PopulationPopulation

There is no intervention done in this study because the data were taken from Swedish Medical Birth Register retrospectively.

InterventionIntervention

This study is comparing APGAR scores between infants that were born in hospitals with 100% oxygen resuscitation versus infants in hospitals with 40% oxygen resuscitation

ComparativeComparative

Konsentrasi oksigen yang lebih baik digunakan untuk resusitasi yaitu 40% atau 100%

OutcomeOutcome

a. Apakah fokus penelitian ini sesuai dengan tujuan penelitian? Ya, Penelitian ini difokuskan untuk memenuhi tujuan

penelitiana. Apakah penulis menggunakan metode yang tepat? Ya, dalam penellitian ini digunakan metode penelitan

berbasis populasi cross sectionala. Apakah subjek penelitian diambil dengan cara yang tepat? Tidak. Dalam jurnal ini tidak dijelaskan bagaimana cara

peneliti mengumpulkan sampel

ValidityValidity

a. Apakah data yang dikumpulkan sesuai dengan tujuan penelitian?

Ya. Data dikumpulkan dari rekam medis dan sudah sesuai dengan tujuan penelitian

a. Apakah penelitian ini mempunyai jumlah subjek yang cukup untuk meminimalisir kebetulan?

Tidak. Pada penelitian ini tidak disebutkan berapa besar sampel minimal

a. Apakah analisa data dilakukan cukup baik? Ya, analisa yang digunakan tes parametrik dan non

parametrik analisis kovarian, regresi logistik (Gauss, APTEC Sistem, Maple Valley, WA)

Ya. Penelitian ini penting karena dapat mengetahui konsentrasi oksigen yang lebih baik ( 40% dan 100%) digunakan untuk resusitasi neonatus yang dinilai berdasarkan perbaikan dari APGAR skor menit ke-1, 5 dan 10 serta penurunan angka kematian bayi.

ImportanceImportance

Penelitian ini dapat diterapkan diindonesia

ApplicabilityApplicability

ThankyoThankyou!u!