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Published ahead of print on September 1, 2005, doi:10.1164/rccm.200412-1740OC

Am. J. Respir. Crit. Care Med., Volume 172, Number 11, December 2005, 1393-1398

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Submitted on December 23, 2004
Accepted on August 31, 2005

Room-air Resuscitation Causes Less Damage to Heart and Kidney Than 100% Oxygen

Maximo Vento1*, Juan Sastre2, Miguel A Asensi2, and Jose Vina2

1 Servicio de Neonatologia, Hospital Universitario Materno-Infantil La Fe, Valencia, Spain, 2 Departamento de Fisiologia, University of Valencia, Valencia, Spain

* To whom correspondence should be addressed. E-mail: maximo.vento{at}uv.es.

Rationale Pure oxygen causes more oxidative stress than room air in resuscitation of asphyctic neonates, and consequently could be associated with increased tissue damage. Objectives To compare damage caused to heart and kidneys on reoxygenation in severely asphyctic term neonates resuscitated with room air (RAR) or 100% oxygen (OxR). Non-asphyxiated term newborn infants acted as a control group. Methods and Measurements This is a prospective randomized clinical trial masked for the gas mixture. Reduced (GSH), oxidized (GSSG) glutathione, and superoxide dismutase (SOD) activity were measured to assess oxidative stress. Plasma cardiac troponin T (cTnT) and urinary N-acetyl-glucosaminidase (NAG) assessed cardiac and renal damage respectively. Daily determinations of NAG for a two-week period were performed to further monitoring post-asphyctic renal damage. Main Results Both asphyxiated groups showed oxidative stress evidenced by diminished GSH/GSSG ratio and an adaptive increase in SOD activity as well as higher values of NAG and cTnT as markers of tissue damage when compared to the control group. However, the OxR group showed significantly higher values of NAG and cTnT, lower GSH/GSSG ratio, and increased SOD activity than the RAR group. Moreover, NAG values persisted in being higher in the OxR group for two weeks after birth, while the RAR group levels of NAG returned to normality within the first week. A linear correlation between cTnT or NAG and GSSG was found. Conclusions The use of room air upon resuscitation causes less oxidative stress and damage to heart and kidney than pure oxygen.
Key words: Birth asphyxia, room-air resuscitation, oxidative stress, glutathione




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