Journal Reading

Critical Appraisal Journal Reading

Oxygen Therapy in Neonates

Frandi Wirajaya, S.Ked (04111401019)
Retno Tharra, S.Ked (04111401029)
Sellita Seplana, S.Ked (04111001054)

Pembimbing:
dr. Indrayadi, Sp.A

Introduction
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.

Purpose
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.

Methods
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

Methods
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

Result

Result

Result

Discussion
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.

Discussion
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 5minute 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: 4553) and cerebral palsy
(relative risk: 31), compared with infants
with 5-minute Apgar scores of 7.

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

PICO VIA

Patient/Problem/Populatio
n
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.

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

Comparative
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

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

Validity
a. Apakah fokus penelitian ini sesuai dengan tujuan penelitian?
Ya, Penelitian ini difokuskan untuk memenuhi tujuan
penelitian
a. Apakah penulis menggunakan metode yang tepat?
Ya, dalam penellitian ini digunakan metode penelitan
berbasis populasi cross sectional
a. Apakah subjek penelitian diambil dengan cara yang tepat?
Tidak. Dalam jurnal ini tidak dijelaskan bagaimana cara
peneliti mengumpulkan sampel

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)

Importance
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.

Applicability
Penelitian ini dapat diterapkan
diindonesia

Thankyo