- Email: [email protected]
Fifty years ago in the Journal of Pediatrics
36. Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J. Clinical signs and symptoms predicting influenza infection. Arch Intern Med 2000;160:3243-7. 37. Orenstein WA, Bernier RH, Hinman AR. Assessing vaccine efficacy in the field: further observations. Epidemiol Rev 1988;10:212-41. 38. Maeda T, Shintani Y, Nakano K, Terashima K, Yamada Y. Failure of inactivated influenza A vaccine to protect healthy children age 6-24 months. Pediatr Int 2004;46:122-5.
39. Centers for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1997;46:RR-7. 40. Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2000;49:RR-9.
Fifty years ago in The Journal of Pediatrics THE
RELATIONSHIP OF PARANATAL EXPERIENCES TO OXYGEN SATURATION IN NEWBORN INFANTS.
Pennoyer MM, Graham FJ, Hartmann AF, Jones B, Mccoy EL, Swarm PA, et al. J Pediatr 1956;49:685-98
This study evaluated the effects of obstetrical variables on oxygen saturation at delivery and at 10, 30, and 60 minutes of life. The methodology involved the then newly developed spectrophotometric determination of oxygen saturation using cord and then capillary blood samples. The researchers compared duration and depth of anesthesia, and fetal and delivery complications, and they reported that cord saturations were higher in infants delivered following pudendal blocks compared with inhalation or caudal blocks. The cord oxygen saturation varied from 10% to 90% with the most frequent values between 60% and 69%, and capillary values between 80% and 90% at 10 minutes in their 232 vaginally delivered infants. Their cord blood gas saturations were 61% (46%-70%) in their uncomplicated deliveries including those with prenatal complications, compared with 54% in the infants with delivery complications, including the use of fundal pressure, breech presentation, and prematurity. The mean saturation at 10 minutes was approximately 81%, and they also reported that 29% of their prenatal complicated infants and 37% of the delivery complicated infants failed to achieve saturations of 90% by 1 hour compared with 21% of the uncomplicated group. They noted that the presence of prenatal complications alone did not lower the oxygen saturations at birth. Fifty years later, we are still trying to determine the normal values for oxygen saturation at delivery and within the first 10 minutes of life, albeit using pulse oximeters. It is indeed impressive that Pennoyer et al using their techniques reported values on more infants than any of the most recent studies using oximeter values following delivery. Recent studies have reported that the oxygen saturation determined by pulse oximetry (SpO2) at 1 minute was 63% to 70% with a gradual increase to 90% by 8 to 15 minutes. We are now in the midst of the debate as to whether we should use oxygen, room air, or some blended value in between for the resuscitation of newborn infants with difficulty at birth. It is important to remember that cord SpO2 values are normally approximately 50% to 55% in the noncompromised infant and increase to 90% by approximately 10 minutes of age. The best available current information indicates that the majority of term infants with asphyxia can be safely and effectively initially resuscitated with room air, and that such an approach is associated with higher Apgar scores, a shorter interval to initiate sustained breathing, and a lower mortality. The observations of Pennoyer et al combined with those of more recent studies provide potential guidelines for the use of oxygen during resuscitation for those infants whose oxygen saturations are significantly below the established limits of SpO2 during the first 10 to 15 minutes of life. It is astonishing how relevant and useful these observations remain 50 years later. Neil N. Finer, MD Division of Neonatology, University of California San Diego, San Diego, CA 10.1016/j.jpeds.2006.07.003
762
Allison et al
The Journal of Pediatrics • December 2006
39. Centers for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and young children. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 1997;46:RR-7. 40. Centers for Disease Control and Prevention. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2000;49:RR-9.
Fifty years ago in The Journal of Pediatrics THE
RELATIONSHIP OF PARANATAL EXPERIENCES TO OXYGEN SATURATION IN NEWBORN INFANTS.
Pennoyer MM, Graham FJ, Hartmann AF, Jones B, Mccoy EL, Swarm PA, et al. J Pediatr 1956;49:685-98
This study evaluated the effects of obstetrical variables on oxygen saturation at delivery and at 10, 30, and 60 minutes of life. The methodology involved the then newly developed spectrophotometric determination of oxygen saturation using cord and then capillary blood samples. The researchers compared duration and depth of anesthesia, and fetal and delivery complications, and they reported that cord saturations were higher in infants delivered following pudendal blocks compared with inhalation or caudal blocks. The cord oxygen saturation varied from 10% to 90% with the most frequent values between 60% and 69%, and capillary values between 80% and 90% at 10 minutes in their 232 vaginally delivered infants. Their cord blood gas saturations were 61% (46%-70%) in their uncomplicated deliveries including those with prenatal complications, compared with 54% in the infants with delivery complications, including the use of fundal pressure, breech presentation, and prematurity. The mean saturation at 10 minutes was approximately 81%, and they also reported that 29% of their prenatal complicated infants and 37% of the delivery complicated infants failed to achieve saturations of 90% by 1 hour compared with 21% of the uncomplicated group. They noted that the presence of prenatal complications alone did not lower the oxygen saturations at birth. Fifty years later, we are still trying to determine the normal values for oxygen saturation at delivery and within the first 10 minutes of life, albeit using pulse oximeters. It is indeed impressive that Pennoyer et al using their techniques reported values on more infants than any of the most recent studies using oximeter values following delivery. Recent studies have reported that the oxygen saturation determined by pulse oximetry (SpO2) at 1 minute was 63% to 70% with a gradual increase to 90% by 8 to 15 minutes. We are now in the midst of the debate as to whether we should use oxygen, room air, or some blended value in between for the resuscitation of newborn infants with difficulty at birth. It is important to remember that cord SpO2 values are normally approximately 50% to 55% in the noncompromised infant and increase to 90% by approximately 10 minutes of age. The best available current information indicates that the majority of term infants with asphyxia can be safely and effectively initially resuscitated with room air, and that such an approach is associated with higher Apgar scores, a shorter interval to initiate sustained breathing, and a lower mortality. The observations of Pennoyer et al combined with those of more recent studies provide potential guidelines for the use of oxygen during resuscitation for those infants whose oxygen saturations are significantly below the established limits of SpO2 during the first 10 to 15 minutes of life. It is astonishing how relevant and useful these observations remain 50 years later. Neil N. Finer, MD Division of Neonatology, University of California San Diego, San Diego, CA 10.1016/j.jpeds.2006.07.003
762
Allison et al
The Journal of Pediatrics • December 2006