array:19 [
  "pii" => "13087867"
  "issn" => "16954033"
  "doi" => "10.1157/13087866"
  "estado" => "S300"
  "fechaPublicacion" => "2006-05-01"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "An Pediatr (Barc). 2006;64:419-21"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 7120
    "formatos" => array:3 [
      "EPUB" => 94
      "HTML" => 6407
      "PDF" => 619
    ]
  ]
  "itemSiguiente" => array:16 [
    "pii" => "13087866"
    "issn" => "16954033"
    "doi" => "10.1157/13087866"
    "estado" => "S300"
    "fechaPublicacion" => "2006-05-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr (Barc). 2006;64:419-21"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 7749
      "formatos" => array:3 [
        "EPUB" => 118
        "HTML" => 7060
        "PDF" => 571
      ]
    ]
    "es" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Reanimación normoxémica en la sala de partos"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "419"
          "paginaFinal" => "421"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Normoxemic resuscitation in the delivery room"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M Vento Torres, OD Saugstad, S Ramji"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "M"
              "apellidos" => "Vento Torres"
            ]
            1 => array:2 [
              "Iniciales" => "OD"
              "apellidos" => "Saugstad"
            ]
            2 => array:2 [
              "Iniciales" => "S"
              "apellidos" => "Ramji"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13087866?idApp=UINPBA00005H"
    "url" => "/16954033/0000006400000005/v0_201404151111/13087866/v0_201404151111/es/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "titulo" => "Normoxemic Resuscitation in the Delivery Room"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "419"
        "paginaFinal" => "421"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M Vento Torres, OD Saugstad, S Ramji"
        "autores" => array:3 [
          0 => array:3 [
            "Iniciales" => "M"
            "apellidos" => "Vento Torres"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "OD"
            "apellidos" => "Saugstad"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "S"
            "apellidos" => "Ramji"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Neonatología. Hospital Universitario Materno-Infantil La Fe. Valencia."
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Director of the Pediatric Research Institute. Rikshospitalet. University of Oslo. Norway."
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Director of the Neonatal Division. Maulana Azad Medical College. New Delhi. India."
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Reanimaci&#243;n normox&#233;mica en la sala de partos"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">The 2005 Guidelines of the International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science &#40;Neonatal Resuscitation Section&#59; part 7&#41; have introduced substantial modifications in the use of supplementary oxygen in comparison with the previous 2000 Guidelines <span class="elsevierStyleSup">1&#44;2</span>&#46; Thus&#44; the current Guidelines do not recommend a specific oxygen concentration for initiating resuscitation as opposed to the previous guidelines which recommended 100 &#37; oxygen &#40;sic&#41;&#58; <span class="elsevierStyleItalic">&#34;There is insufficient evidence to specify the concentration of oxygen to be used at initiation of resuscitation&#34;</span><span class="elsevierStyleSup">1&#44;2</span><span class="elsevierStyleItalic">&#46;</span> Thus&#44; the use of supplementary 100 &#37; oxygen for the initiation of ventilation can no longer be regarded as the standard of care&#46; In addition&#44; the guidelines indicate that&#44; even if heart rate does not improve after adequate ventilation&#44; the priority should be to secure cardiac output by chest compression&#44; since there is no evidence that modifying the inspired oxygen concentration will improve prognosis <span class="elsevierStyleSup">1</span>&#46; Finally&#44; the present guidelines caution against adjusting the oxygen supply to pulse oximetry because reliable values of oxygen saturation following birth are lacking <span class="elsevierStyleSup"> 1</span>&#46; These statements serve only to confirm the uncertainty that surrounds specific aspects of neonatal resuscitation&#46; In the present editorial&#44; we propose to clarify the pathophysiologic sequence of events following the use of excess oxygen with the aim of facilitating decision making by health professionals faced with an asphyxiated neonate&#46;</p><p class="elsevierStylePara">Evidence accumulated in recent years has shown that room air is at least as effective&#44; if not more so&#44; than 100 &#37; oxygen in resuscitating asphyxiated newborn infants above 1&#46;000 g of birth weight <span class="elsevierStyleSup">3-7</span>&#46; Moreover&#44; meta-analyses of these studies have shown reduced mortality in room-air resuscitated infants <span class="elsevierStyleSup">8&#44;9</span>&#44; and follow-up of the surviving infants at 2 years of age showed no differences in neurological sequelae between the two groups <span class="elsevierStyleSup"> 10</span>&#46; The combined available evidence prompted the International Liaison Committee on Resuscitation &#40;ILCOR&#41; to modify the standard of care in relation to the use of supplementary oxygen in delivery room resuscitation of newborn infants <span class="elsevierStyleSup"> 2</span>&#46;</p><p class="elsevierStylePara">Several studies were published after the ILCOR meeting in January 2005 and were therefore not included in the formulation of the current Guidelines&#46; A study performed by an independent group of researchers &#40;other than the authors&#41; has confirmed the safety of room air for resuscitating asphyxiated newborn infants <span class="elsevierStyleSup"> 11</span>&#46; Secondly&#44; a comprehensive meta-analysis including the full information present in the databases of the investigators who performed the previous clinical studies <span class="elsevierStyleSup">3-7</span> demonstrated reduced mortality in room-air resuscitated infants compared with those resuscitated with pure oxygen <span class="elsevierStyleSup">12</span>&#46; In another study&#44; which used specific biochemical markers&#44; increased damage to organs such as heart and kidney in the first days of life was observed when pure oxygen was used as compared to room air <span class="elsevierStyleSup"> 13</span>&#46; In fact&#44; a statistically significant correlation between markers of oxidative stress &#40;reduced&#47;oxidized glutathione &#91;GSH&#47;GSSG&#93; ratio&#41; and of cardiac &#91;cardiac troponin T &#40;cTnT&#41;&#93; and renal damage &#40;N-acetyl-glucosaminidase&#41; was found <span class="elsevierStyleSup">13</span>&#46; Finally&#44; a further study underscored the importance of cardiac frequency as a simple and reliable means of evaluating response to resuscitation&#44; as well as the high sensitivity and specificity of pulse oximetry in predicting outcome <span class="elsevierStyleSup">14</span>&#46;</p><p class="elsevierStylePara">In the last 10 years&#44; hundreds of infants have been effectively resuscitated with room air in clinical trials globally <span class="elsevierStyleSup">12</span>&#46; Although not all of these infants suffered from severe asphyxia&#44; all of them needed positive pressure ventilation to overcome postnatal respiratory depression&#46; The use of room air significantly shortened the duration of resuscitation by several minutes <span class="elsevierStyleSup">8&#44;9&#44;12</span>&#46; The mean volume of excess oxygen that each infant resuscitated with 100 &#37; oxygen received as compared to those resuscitated with room-air amounted to around 115 ml per kilogram of body weight <span class="elsevierStyleSup">7</span>&#46; Most of these newborn infants did not have pulmonary disease and therefore the oxygen supplied with positive pressure could freely reach the alveolar surface&#46; Although it is well known that the alveolar lining fluid contains a substantial concentration of antioxidants&#44; especially extracellular superoxide dismutase and GSH&#44; this antioxidant defense barrier has proven insufficient to scavenge the burst of oxygen free radicals produced during the hypoxic-reoxygenation process characterizing asphyxia&#46; Thus&#44; in previous studies&#44; the GSH&#47;GSSG ratio was significantly diminished in infants resuscitated with 100 &#37; oxygen as compared to those resuscitated with room-air&#44; indicating the presence of oxidative stress <span class="elsevierStyleSup">5</span>&#46; Moreover&#44; the use of 100 &#37; oxygen during resuscitation caused hyperoxemia as measured in arterial blood gases performed during resuscitation&#44; while partial pressure of oxygen remained within the physiologic range in room-air resuscitated neonates <span class="elsevierStyleSup">7</span>&#46; Thus&#44; a significantly decreased GSH&#47;GSSG ratio and activation of the glutathione redox enzymes were found in pure oxygen resuscitated infants as compared to room-air resuscitated infants <span class="elsevierStyleSup">14</span>&#46; In addition&#44; there was a significant correlation between the concentrations of GSSG and arterial partial pressure of oxygen&#44; indicating that hyperoxemia led to a pro-oxidant status <span class="elsevierStyleSup">7</span>&#46;</p><p class="elsevierStylePara">Do these findings have a clinical correlate&#44; or are they simply biochemical data with only theoretical implications&#63; A recent prospective randomized clinical study blinded for the gas source reported that markers of cardiac &#40;cTnT&#41; and renal damage &#91;N-acetyl-glucosaminidase &#40;NAG&#41;&#93; were increased in plasma and urine respectively in severely asphyxiated newborn infants after birth <span class="elsevierStyleSup">13</span>&#46; However&#44; infants ventilated with pure oxygen had significantly higher concentrations of cTnT and NAG during the first days of life than those resuscitated with room air and&#44; remarkably&#44; there was a significant correlation between markers of cardiac and renal damage and GSSG <span class="elsevierStyleSup">13</span>&#46; Our studies have described a sequence of pathophysiologic events in the human neonate derived from the administration of excess oxygen after a prolonged hypoxic-ischemic event&#46; The use of 100 &#37; oxygen delays the onset of spontaneous respiration thus prolonging the duration of positive pressure ventilation&#46; As a consequence&#44; a cascade of events is triggered&#58; hyperoxemia&#44; production of oxygen free radicals&#44; oxidative stress and increased tissue damage&#46; We hypothesize that this sequence of events could explain the increased mortality observed in newborn infants resuscitated with pure oxygen <span class="elsevierStyleSup">8&#44;9&#44;12</span>&#46;</p><p class="elsevierStylePara">The principal clinical repercussion of all of the above is that excess oxygen supplementation to tissues after an asphyxia episode should be unequivocally avoided&#46; The 2005 Guidelines are skeptical about the reliability of continuous pulse oximetry as a guide to determining oxygen needs during resuscitation <span class="elsevierStyleSup">1</span>&#46; However&#44; faced with a dilemma on the need or otherwise for oxygen supplementation&#44; monitoring of arterial oxygen saturation &#40;SaO<span class="elsevierStyleInf">2</span>&#41; using continuous oximetry&#44; and especially the use of oximeters that incorporate signal extraction technology&#44; is still the most reliable method of adjusting individual oxygen needs during resuscitation&#46; Interestingly&#44; in a large group of asphyxiated patients&#44; we found that SaO<span class="elsevierStyleInf">2</span> at 1 min of life gave the highest sensitivity and specificity regarding death in the first week of life <span class="elsevierStyleSup">15</span>&#46; Moreover&#44; the receiver operating curve &#40;ROC&#41; for SaO<span class="elsevierStyleInf">2</span> at 1 min as a predictor of death in the first week of life gave the highest area under the curve &#40;0&#46;84&#41; compared with other indicators such as heart rate at different times&#44; Apgar score&#44; and hypoxic ischemic encephalopathy grade II&#47;III <span class="elsevierStyleSup">15</span>&#46; However&#44; as stated by the ILCOR&#44; further studies are required to determine the normal SaO<span class="elsevierStyleInf">2</span> curves of infants of distinct gestational ages in the first minutes of life&#46; These normality curves would guide the need for oxygen in individualized cases&#44; thus helping to avoid excess oxygen supplementation and its deleterious consequences&#46;</p><p class="elsevierStylePara">A substantial number of editorials have analyzed studies that have compared room-air resuscitation versus 100 &#37; oxygen <span class="elsevierStyleSup">16-21</span>&#46; The main criticism of these studies concerns randomization and the small number of infants recruited&#46; However&#44; all authors agree on the difficulty of performing such studies and on the urgent need for a large&#44; multicenter&#44; randomized clinical trial&#46; As stated by Prof&#46; Tarnow-Mordy&#44; performing a classical randomized clinical trial with the aim of reducing mortality or brain damage from 24 &#37; to 21 &#37; with a power of 80 &#37; and a two-sided a of 0&#46;05&#44; would require 7000 asphyxiated neonates <span class="elsevierStyleSup">16</span>&#46; This approach is nowadays impossible to put into practice&#46; However&#44; as proposed by Prof&#46; R J Martin&#44; there are other alternatives&#44; which are feasible and highly informative <span class="elsevierStyleSup">21</span>&#46; Thus&#44; a non-inferiority trial &#40;a specific concentration of oxygen is as good as 100 &#37; oxygen&#41; could be performed&#46; Another possibility would be to use titrated oxygen supplementation controlled by pulse oximetry initiated immediately after birth&#44; setting a small margin of equivalence and high power to minimize the chances of incorrectly concluding that a new approach is equivalent to 100 &#37; oxygen when in fact it is inferior <span class="elsevierStyleSup">20</span>&#46; Either of these alternatives&#44; and even others that could be designed by competent epidemiologists&#44; would allow a valid and informative prospective randomized study with a population of around 700 newborn infants to be performed&#44; which is perfectly feasible and highly desirable&#46;</p><p class="elsevierStylePara">In the future it is highly probable that newborn infants will be monitored by a new generation pulse oximeters&#44; which will allow us to accurately determine SaO<span class="elsevierStyleInf">2</span> in the newborn infant immediately after birth&#46; Resuscitation should then be guided according to normal SaO<span class="elsevierStyleInf">2</span> development&#46; Until then we will have to rely on the response of heart rate to positive pressure ventilation and the SaO<span class="elsevierStyleInf">2</span> values described in recent scientific literature&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold"> Correspondence&#58;</span> M&#225;ximo Vento Torres&#44; MD&#46;<br></br> Servicio de Neonatolog&#237;a&#46; Hospital Universitario Materno-Infantil La Fe&#46;<br></br> Avda&#46; de Campanar&#44; 21&#46; 46009 Valencia&#46; Spain&#46;<br></br> E-mail&#58; <a href="mailto&#58;maximo&#46;vento&#64;uv&#46;es" class="elsevierStyleCrossRefs"> maximo&#46;vento&#64;uv&#46;es</a></p>"
    "pdfFichero" => "37v64n05a13087867pdf001.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Neonatal Resuscitation Guidelines&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
                        "volumen" => "112"
                        "paginaInicial" => "III"
                        "paginaFinal" => "91"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16116064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Part 11: Neonatal Resuscitation. Circulation. 2000;102 Suppl I:1343-58."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care&#58; International Consensus on Science&#46; Part 11&#58; Neonatal Resuscitation&#46; Circulation&#46; 2000&#59;102 Suppl I&#58;1343-58&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Heart Association in collaboration with International Liaison Committee on Resuscitation&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of the asphyxic newborn infants with room air or 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Ramji S"
                            1 => "Ahuja S"
                            2 => "Thirupuram S"
                            3 => "Rootwelt T"
                            4 => "Rooth G"
                            5 => "Saugstad OD&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1203/00006450-199312000-00023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "1993"
                        "volumen" => "34"
                        "paginaInicial" => "809"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8108199"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of newborn infants with room air or oxygen&#58; an international controlled trial&#58; The Resair 2 study&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Saugstad OD"
                            1 => "Rootwelt T"
                            2 => "Aalen O &#40;and the Resair 2 group&#41;&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1998"
                        "volumen" => "102"
                        "paginaInicial" => "e1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9651453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation with room air instead of 100 &#37; oxygen prevents oxidative stress in moderately asphyxiated term neonates&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Vento M"
                            1 => "Asensi M"
                            2 => "Sastre J"
                            3 => "Garc&#237;a-Sala F"
                            4 => "Pallardo FV"
                            5 => "Vi&#241;a J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2001"
                        "volumen" => "107"
                        "paginaInicial" => "642"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11335737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of asphyxiated newborns with room air or 100 &#37; oxygen at birth&#58; A multicentric clinical trial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Ramji S"
                            1 => "Rasaily R"
                            2 => "Mishra PK"
                            3 => "Narang A"
                            4 => "Jayam S"
                            5 => "Kapoor AN"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian Pediatr"
                        "fecha" => "2003"
                        "volumen" => "40"
                        "paginaInicial" => "510"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12824660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Oxidative stress in asphyxiated term infants resuscitated with 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Vento M"
                            1 => "Asensi M"
                            2 => "Sastre J"
                            3 => "Lloret A"
                            4 => "Garc&#237;a-Sala F"
                            5 => "Vi&#241;a J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2003"
                        "volumen" => "142"
                        "paginaInicial" => "240"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12640369"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Air versus oxygen for resuscitation of infants at birth. Cochrane Database Syst Rev. 2004;CD002273."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Air versus oxygen for resuscitation of infants at birth&#46; Cochrane Database Syst Rev&#46; 2004&#59;CD002273&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Tan A"
                            1 => "Shulze A"
                            2 => "O&#39;Donnell CP"
                            3 => "Davis PG&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of newborn infants with 100 &#37; oxygen or air&#58; a systematic review and meta-analysis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Davis PG"
                            1 => "Tan A"
                            2 => "O&#39;Donnell CP"
                            3 => "Schulze A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)17189-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "1329"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15474135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of newborn infants with 21 &#37; or 100 &#37; oxygen&#58; Follow-Up at 18 to 24 months&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Saugstad OD"
                            1 => "Ramji S"
                            2 => "Irani SF"
                            3 => "El-Meneza S"
                            4 => "Hern&#225;ndez EA"
                            5 => "Vento M"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2003"
                        "volumen" => "112"
                        "paginaInicial" => "296"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12897277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Room air vs&#46; 100 per cent oxygen for neonatal resuscitation&#58; A controlled clinical trial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Bajaj N"
                            1 => "Udani RH"
                            2 => "Nanavati RN&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/tropej/fmh086"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trop Pediatr"
                        "fecha" => "2005"
                        "volumen" => "51"
                        "paginaInicial" => "206"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15927951"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of depressed newborn infants with ambient air or pure oxygen&#58; A meta-analysis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Saugstad OD"
                            1 => "Ramji S"
                            2 => "Vento M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000080950"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Neonate"
                        "fecha" => "2005"
                        "volumen" => "87"
                        "paginaInicial" => "27"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15452400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Room-air resuscitation causes less damage to heart and kidney than 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Vento M"
                            1 => "Sastre J"
                            2 => "Asensi M"
                            3 => "Vi&#241;a J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200412-1740OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Resp Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "172"
                        "paginaInicial" => "1393"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Hyperoxemia caused by resuscitation with pure oxygen may alter intracellular redox status by increasing oxidized glutathione in asphyxiated newly born infants&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Vento M"
                            1 => "Asensi M"
                            2 => "Sastre J"
                            3 => "Lloret A"
                            4 => "Garc&#237;a-Sala F"
                            5 => "Mi&#241;ana JB"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Perinatol"
                        "fecha" => "2002"
                        "volumen" => "26"
                        "paginaInicial" => "406"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12537311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Response to resuscitation of the newborn&#58; Early prognostic variables&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Saugstad OD"
                            1 => "Ramji S"
                            2 => "Rootwelt T"
                            3 => "Vento M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/08035250510036507"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatrica"
                        "fecha" => "2005"
                        "volumen" => "94"
                        "paginaInicial" => "890"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16188811"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Tarnow-Mordi WO&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)60464-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Room air or oxygen for asphyxiated babies? Lancet"
                        "fecha" => "1998"
                        "volumen" => "352"
                        "paginaInicial" => "341"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9717918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Robbins Levine C"
                            1 => "Davis JM&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "% oxygen:Should we change our ways? Pediatr Res"
                        "fecha" => "2001"
                        "volumen" => "50"
                        "paginaInicial" => "432"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Evaluating resuscitation practices on the basis of evidence&#58; The findings at first glance may seem illogical&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Kattwinkel J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mpd.2003.147"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2003"
                        "volumen" => "142"
                        "paginaInicial" => "221"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12640361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Oxygen toxicity at birth&#58; The pieces are put together&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Saugstad OD&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "2003"
                        "volumen" => "54"
                        "paginaInicial" => "789"
                        "itemHostRev" => array:3 [
                          "pii" => "S1130140610000616"
                          "estado" => "S300"
                          "issn" => "11301406"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The evidence mounts against use of pure oxygen in newborn resuscitation&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Paneth N&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2005.04.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2005"
                        "volumen" => "147"
                        "paginaInicial" => "4"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16027683"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Reevaluating neonatal resuscitation with 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Martin RJ"
                            1 => "Walsh MC"
                            2 => "Carlo WA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2509002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Resp Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "172"
                        "paginaInicial" => "1360"
                        "paginaFinal" => "1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16301299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16954033/0000006400000005/v0_201404151111/13087867/v0_201404151111/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14281"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16954033/0000006400000005/v0_201404151111/13087867/v0_201404151111/en/37v64n05a13087867pdf001.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13087867?idApp=UINPBA00005H"
]
Compartir
Información de la revista

Estadísticas

Siga este enlace para acceder al texto completo del artículo

Normoxemic Resuscitation in the Delivery Room
Reanimación normoxémica en la sala de partos
M. Vento Torresa, OD. Saugstadb, S. Ramjic
a Servicio de Neonatología. Hospital Universitario Materno-Infantil La Fe. Valencia.
b Director of the Pediatric Research Institute. Rikshospitalet. University of Oslo. Norway.
c Director of the Neonatal Division. Maulana Azad Medical College. New Delhi. India.
Leído
10547
Veces
se ha leído el artículo
2221
Total PDF
8326
Total HTML
Compartir estadísticas
 array:19 [
  "pii" => "13087867"
  "issn" => "16954033"
  "doi" => "10.1157/13087866"
  "estado" => "S300"
  "fechaPublicacion" => "2006-05-01"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "An Pediatr &#40;Barc&#41;. 2006;64:419-21"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 7120
    "formatos" => array:3 [
      "EPUB" => 94
      "HTML" => 6407
      "PDF" => 619
    ]
  ]
  "itemSiguiente" => array:16 [
    "pii" => "13087866"
    "issn" => "16954033"
    "doi" => "10.1157/13087866"
    "estado" => "S300"
    "fechaPublicacion" => "2006-05-01"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2006;64:419-21"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 7749
      "formatos" => array:3 [
        "EPUB" => 118
        "HTML" => 7060
        "PDF" => 571
      ]
    ]
    "es" => array:9 [
      "idiomaDefecto" => true
      "titulo" => "Reanimaci&#243;n normox&#233;mica en la sala de partos"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "419"
          "paginaFinal" => "421"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Normoxemic resuscitation in the delivery room"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M Vento Torres, OD Saugstad, S Ramji"
          "autores" => array:3 [
            0 => array:2 [
              "Iniciales" => "M"
              "apellidos" => "Vento Torres"
            ]
            1 => array:2 [
              "Iniciales" => "OD"
              "apellidos" => "Saugstad"
            ]
            2 => array:2 [
              "Iniciales" => "S"
              "apellidos" => "Ramji"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13087866?idApp=UINPBA00005H"
    "url" => "/16954033/0000006400000005/v0_201404151111/13087866/v0_201404151111/es/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "titulo" => "Normoxemic Resuscitation in the Delivery Room"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "419"
        "paginaFinal" => "421"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M Vento Torres, OD Saugstad, S Ramji"
        "autores" => array:3 [
          0 => array:3 [
            "Iniciales" => "M"
            "apellidos" => "Vento Torres"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "affa"
              ]
            ]
          ]
          1 => array:3 [
            "Iniciales" => "OD"
            "apellidos" => "Saugstad"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "affb"
              ]
            ]
          ]
          2 => array:3 [
            "Iniciales" => "S"
            "apellidos" => "Ramji"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "affc"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Neonatología. Hospital Universitario Materno-Infantil La Fe. Valencia."
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "affa"
          ]
          1 => array:3 [
            "entidad" => "Director of the Pediatric Research Institute. Rikshospitalet. University of Oslo. Norway."
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "affb"
          ]
          2 => array:3 [
            "entidad" => "Director of the Neonatal Division. Maulana Azad Medical College. New Delhi. India."
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "affc"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Reanimaci&#243;n normox&#233;mica en la sala de partos"
      ]
    ]
    "textoCompleto" => "<p class="elsevierStylePara">The 2005 Guidelines of the International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science &#40;Neonatal Resuscitation Section&#59; part 7&#41; have introduced substantial modifications in the use of supplementary oxygen in comparison with the previous 2000 Guidelines <span class="elsevierStyleSup">1&#44;2</span>&#46; Thus&#44; the current Guidelines do not recommend a specific oxygen concentration for initiating resuscitation as opposed to the previous guidelines which recommended 100 &#37; oxygen &#40;sic&#41;&#58; <span class="elsevierStyleItalic">&#34;There is insufficient evidence to specify the concentration of oxygen to be used at initiation of resuscitation&#34;</span><span class="elsevierStyleSup">1&#44;2</span><span class="elsevierStyleItalic">&#46;</span> Thus&#44; the use of supplementary 100 &#37; oxygen for the initiation of ventilation can no longer be regarded as the standard of care&#46; In addition&#44; the guidelines indicate that&#44; even if heart rate does not improve after adequate ventilation&#44; the priority should be to secure cardiac output by chest compression&#44; since there is no evidence that modifying the inspired oxygen concentration will improve prognosis <span class="elsevierStyleSup">1</span>&#46; Finally&#44; the present guidelines caution against adjusting the oxygen supply to pulse oximetry because reliable values of oxygen saturation following birth are lacking <span class="elsevierStyleSup"> 1</span>&#46; These statements serve only to confirm the uncertainty that surrounds specific aspects of neonatal resuscitation&#46; In the present editorial&#44; we propose to clarify the pathophysiologic sequence of events following the use of excess oxygen with the aim of facilitating decision making by health professionals faced with an asphyxiated neonate&#46;</p><p class="elsevierStylePara">Evidence accumulated in recent years has shown that room air is at least as effective&#44; if not more so&#44; than 100 &#37; oxygen in resuscitating asphyxiated newborn infants above 1&#46;000 g of birth weight <span class="elsevierStyleSup">3-7</span>&#46; Moreover&#44; meta-analyses of these studies have shown reduced mortality in room-air resuscitated infants <span class="elsevierStyleSup">8&#44;9</span>&#44; and follow-up of the surviving infants at 2 years of age showed no differences in neurological sequelae between the two groups <span class="elsevierStyleSup"> 10</span>&#46; The combined available evidence prompted the International Liaison Committee on Resuscitation &#40;ILCOR&#41; to modify the standard of care in relation to the use of supplementary oxygen in delivery room resuscitation of newborn infants <span class="elsevierStyleSup"> 2</span>&#46;</p><p class="elsevierStylePara">Several studies were published after the ILCOR meeting in January 2005 and were therefore not included in the formulation of the current Guidelines&#46; A study performed by an independent group of researchers &#40;other than the authors&#41; has confirmed the safety of room air for resuscitating asphyxiated newborn infants <span class="elsevierStyleSup"> 11</span>&#46; Secondly&#44; a comprehensive meta-analysis including the full information present in the databases of the investigators who performed the previous clinical studies <span class="elsevierStyleSup">3-7</span> demonstrated reduced mortality in room-air resuscitated infants compared with those resuscitated with pure oxygen <span class="elsevierStyleSup">12</span>&#46; In another study&#44; which used specific biochemical markers&#44; increased damage to organs such as heart and kidney in the first days of life was observed when pure oxygen was used as compared to room air <span class="elsevierStyleSup"> 13</span>&#46; In fact&#44; a statistically significant correlation between markers of oxidative stress &#40;reduced&#47;oxidized glutathione &#91;GSH&#47;GSSG&#93; ratio&#41; and of cardiac &#91;cardiac troponin T &#40;cTnT&#41;&#93; and renal damage &#40;N-acetyl-glucosaminidase&#41; was found <span class="elsevierStyleSup">13</span>&#46; Finally&#44; a further study underscored the importance of cardiac frequency as a simple and reliable means of evaluating response to resuscitation&#44; as well as the high sensitivity and specificity of pulse oximetry in predicting outcome <span class="elsevierStyleSup">14</span>&#46;</p><p class="elsevierStylePara">In the last 10 years&#44; hundreds of infants have been effectively resuscitated with room air in clinical trials globally <span class="elsevierStyleSup">12</span>&#46; Although not all of these infants suffered from severe asphyxia&#44; all of them needed positive pressure ventilation to overcome postnatal respiratory depression&#46; The use of room air significantly shortened the duration of resuscitation by several minutes <span class="elsevierStyleSup">8&#44;9&#44;12</span>&#46; The mean volume of excess oxygen that each infant resuscitated with 100 &#37; oxygen received as compared to those resuscitated with room-air amounted to around 115 ml per kilogram of body weight <span class="elsevierStyleSup">7</span>&#46; Most of these newborn infants did not have pulmonary disease and therefore the oxygen supplied with positive pressure could freely reach the alveolar surface&#46; Although it is well known that the alveolar lining fluid contains a substantial concentration of antioxidants&#44; especially extracellular superoxide dismutase and GSH&#44; this antioxidant defense barrier has proven insufficient to scavenge the burst of oxygen free radicals produced during the hypoxic-reoxygenation process characterizing asphyxia&#46; Thus&#44; in previous studies&#44; the GSH&#47;GSSG ratio was significantly diminished in infants resuscitated with 100 &#37; oxygen as compared to those resuscitated with room-air&#44; indicating the presence of oxidative stress <span class="elsevierStyleSup">5</span>&#46; Moreover&#44; the use of 100 &#37; oxygen during resuscitation caused hyperoxemia as measured in arterial blood gases performed during resuscitation&#44; while partial pressure of oxygen remained within the physiologic range in room-air resuscitated neonates <span class="elsevierStyleSup">7</span>&#46; Thus&#44; a significantly decreased GSH&#47;GSSG ratio and activation of the glutathione redox enzymes were found in pure oxygen resuscitated infants as compared to room-air resuscitated infants <span class="elsevierStyleSup">14</span>&#46; In addition&#44; there was a significant correlation between the concentrations of GSSG and arterial partial pressure of oxygen&#44; indicating that hyperoxemia led to a pro-oxidant status <span class="elsevierStyleSup">7</span>&#46;</p><p class="elsevierStylePara">Do these findings have a clinical correlate&#44; or are they simply biochemical data with only theoretical implications&#63; A recent prospective randomized clinical study blinded for the gas source reported that markers of cardiac &#40;cTnT&#41; and renal damage &#91;N-acetyl-glucosaminidase &#40;NAG&#41;&#93; were increased in plasma and urine respectively in severely asphyxiated newborn infants after birth <span class="elsevierStyleSup">13</span>&#46; However&#44; infants ventilated with pure oxygen had significantly higher concentrations of cTnT and NAG during the first days of life than those resuscitated with room air and&#44; remarkably&#44; there was a significant correlation between markers of cardiac and renal damage and GSSG <span class="elsevierStyleSup">13</span>&#46; Our studies have described a sequence of pathophysiologic events in the human neonate derived from the administration of excess oxygen after a prolonged hypoxic-ischemic event&#46; The use of 100 &#37; oxygen delays the onset of spontaneous respiration thus prolonging the duration of positive pressure ventilation&#46; As a consequence&#44; a cascade of events is triggered&#58; hyperoxemia&#44; production of oxygen free radicals&#44; oxidative stress and increased tissue damage&#46; We hypothesize that this sequence of events could explain the increased mortality observed in newborn infants resuscitated with pure oxygen <span class="elsevierStyleSup">8&#44;9&#44;12</span>&#46;</p><p class="elsevierStylePara">The principal clinical repercussion of all of the above is that excess oxygen supplementation to tissues after an asphyxia episode should be unequivocally avoided&#46; The 2005 Guidelines are skeptical about the reliability of continuous pulse oximetry as a guide to determining oxygen needs during resuscitation <span class="elsevierStyleSup">1</span>&#46; However&#44; faced with a dilemma on the need or otherwise for oxygen supplementation&#44; monitoring of arterial oxygen saturation &#40;SaO<span class="elsevierStyleInf">2</span>&#41; using continuous oximetry&#44; and especially the use of oximeters that incorporate signal extraction technology&#44; is still the most reliable method of adjusting individual oxygen needs during resuscitation&#46; Interestingly&#44; in a large group of asphyxiated patients&#44; we found that SaO<span class="elsevierStyleInf">2</span> at 1 min of life gave the highest sensitivity and specificity regarding death in the first week of life <span class="elsevierStyleSup">15</span>&#46; Moreover&#44; the receiver operating curve &#40;ROC&#41; for SaO<span class="elsevierStyleInf">2</span> at 1 min as a predictor of death in the first week of life gave the highest area under the curve &#40;0&#46;84&#41; compared with other indicators such as heart rate at different times&#44; Apgar score&#44; and hypoxic ischemic encephalopathy grade II&#47;III <span class="elsevierStyleSup">15</span>&#46; However&#44; as stated by the ILCOR&#44; further studies are required to determine the normal SaO<span class="elsevierStyleInf">2</span> curves of infants of distinct gestational ages in the first minutes of life&#46; These normality curves would guide the need for oxygen in individualized cases&#44; thus helping to avoid excess oxygen supplementation and its deleterious consequences&#46;</p><p class="elsevierStylePara">A substantial number of editorials have analyzed studies that have compared room-air resuscitation versus 100 &#37; oxygen <span class="elsevierStyleSup">16-21</span>&#46; The main criticism of these studies concerns randomization and the small number of infants recruited&#46; However&#44; all authors agree on the difficulty of performing such studies and on the urgent need for a large&#44; multicenter&#44; randomized clinical trial&#46; As stated by Prof&#46; Tarnow-Mordy&#44; performing a classical randomized clinical trial with the aim of reducing mortality or brain damage from 24 &#37; to 21 &#37; with a power of 80 &#37; and a two-sided a of 0&#46;05&#44; would require 7000 asphyxiated neonates <span class="elsevierStyleSup">16</span>&#46; This approach is nowadays impossible to put into practice&#46; However&#44; as proposed by Prof&#46; R J Martin&#44; there are other alternatives&#44; which are feasible and highly informative <span class="elsevierStyleSup">21</span>&#46; Thus&#44; a non-inferiority trial &#40;a specific concentration of oxygen is as good as 100 &#37; oxygen&#41; could be performed&#46; Another possibility would be to use titrated oxygen supplementation controlled by pulse oximetry initiated immediately after birth&#44; setting a small margin of equivalence and high power to minimize the chances of incorrectly concluding that a new approach is equivalent to 100 &#37; oxygen when in fact it is inferior <span class="elsevierStyleSup">20</span>&#46; Either of these alternatives&#44; and even others that could be designed by competent epidemiologists&#44; would allow a valid and informative prospective randomized study with a population of around 700 newborn infants to be performed&#44; which is perfectly feasible and highly desirable&#46;</p><p class="elsevierStylePara">In the future it is highly probable that newborn infants will be monitored by a new generation pulse oximeters&#44; which will allow us to accurately determine SaO<span class="elsevierStyleInf">2</span> in the newborn infant immediately after birth&#46; Resuscitation should then be guided according to normal SaO<span class="elsevierStyleInf">2</span> development&#46; Until then we will have to rely on the response of heart rate to positive pressure ventilation and the SaO<span class="elsevierStyleInf">2</span> values described in recent scientific literature&#46;</p><hr></hr><p class="elsevierStylePara"><span class="elsevierStyleBold"> Correspondence&#58;</span> M&#225;ximo Vento Torres&#44; MD&#46;<br></br> Servicio de Neonatolog&#237;a&#46; Hospital Universitario Materno-Infantil La Fe&#46;<br></br> Avda&#46; de Campanar&#44; 21&#46; 46009 Valencia&#46; Spain&#46;<br></br> E-mail&#58; <a href="mailto&#58;maximo&#46;vento&#64;uv&#46;es" class="elsevierStyleCrossRefs"> maximo&#46;vento&#64;uv&#46;es</a></p>"
    "pdfFichero" => "37v64n05a13087867pdf001.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "Bibliography"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:21 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Neonatal Resuscitation Guidelines&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "2005"
                        "volumen" => "112"
                        "paginaInicial" => "III"
                        "paginaFinal" => "91"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16116064"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science. Part 11: Neonatal Resuscitation. Circulation. 2000;102 Suppl I:1343-58."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care&#58; International Consensus on Science&#46; Part 11&#58; Neonatal Resuscitation&#46; Circulation&#46; 2000&#59;102 Suppl I&#58;1343-58&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "American Heart Association in collaboration with International Liaison Committee on Resuscitation&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of the asphyxic newborn infants with room air or 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Ramji S"
                            1 => "Ahuja S"
                            2 => "Thirupuram S"
                            3 => "Rootwelt T"
                            4 => "Rooth G"
                            5 => "Saugstad OD&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1203/00006450-199312000-00023"
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "1993"
                        "volumen" => "34"
                        "paginaInicial" => "809"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8108199"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of newborn infants with room air or oxygen&#58; an international controlled trial&#58; The Resair 2 study&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Saugstad OD"
                            1 => "Rootwelt T"
                            2 => "Aalen O &#40;and the Resair 2 group&#41;&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1998"
                        "volumen" => "102"
                        "paginaInicial" => "e1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9651453"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation with room air instead of 100 &#37; oxygen prevents oxidative stress in moderately asphyxiated term neonates&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Vento M"
                            1 => "Asensi M"
                            2 => "Sastre J"
                            3 => "Garc&#237;a-Sala F"
                            4 => "Pallardo FV"
                            5 => "Vi&#241;a J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2001"
                        "volumen" => "107"
                        "paginaInicial" => "642"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11335737"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of asphyxiated newborns with room air or 100 &#37; oxygen at birth&#58; A multicentric clinical trial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Ramji S"
                            1 => "Rasaily R"
                            2 => "Mishra PK"
                            3 => "Narang A"
                            4 => "Jayam S"
                            5 => "Kapoor AN"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Indian Pediatr"
                        "fecha" => "2003"
                        "volumen" => "40"
                        "paginaInicial" => "510"
                        "paginaFinal" => "7"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12824660"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Oxidative stress in asphyxiated term infants resuscitated with 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Vento M"
                            1 => "Asensi M"
                            2 => "Sastre J"
                            3 => "Lloret A"
                            4 => "Garc&#237;a-Sala F"
                            5 => "Vi&#241;a J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2003"
                        "volumen" => "142"
                        "paginaInicial" => "240"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12640369"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "referenciaCompleta" => "Air versus oxygen for resuscitation of infants at birth. Cochrane Database Syst Rev. 2004;CD002273."
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Air versus oxygen for resuscitation of infants at birth&#46; Cochrane Database Syst Rev&#46; 2004&#59;CD002273&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Tan A"
                            1 => "Shulze A"
                            2 => "O&#39;Donnell CP"
                            3 => "Davis PG&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of newborn infants with 100 &#37; oxygen or air&#58; a systematic review and meta-analysis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Davis PG"
                            1 => "Tan A"
                            2 => "O&#39;Donnell CP"
                            3 => "Schulze A&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)17189-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "1329"
                        "paginaFinal" => "33"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15474135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of newborn infants with 21 &#37; or 100 &#37; oxygen&#58; Follow-Up at 18 to 24 months&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Saugstad OD"
                            1 => "Ramji S"
                            2 => "Irani SF"
                            3 => "El-Meneza S"
                            4 => "Hern&#225;ndez EA"
                            5 => "Vento M"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "2003"
                        "volumen" => "112"
                        "paginaInicial" => "296"
                        "paginaFinal" => "300"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12897277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Room air vs&#46; 100 per cent oxygen for neonatal resuscitation&#58; A controlled clinical trial&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Bajaj N"
                            1 => "Udani RH"
                            2 => "Nanavati RN&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/tropej/fmh086"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Trop Pediatr"
                        "fecha" => "2005"
                        "volumen" => "51"
                        "paginaInicial" => "206"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15927951"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Resuscitation of depressed newborn infants with ambient air or pure oxygen&#58; A meta-analysis&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Saugstad OD"
                            1 => "Ramji S"
                            2 => "Vento M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000080950"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biol Neonate"
                        "fecha" => "2005"
                        "volumen" => "87"
                        "paginaInicial" => "27"
                        "paginaFinal" => "34"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15452400"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Room-air resuscitation causes less damage to heart and kidney than 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Vento M"
                            1 => "Sastre J"
                            2 => "Asensi M"
                            3 => "Vi&#241;a J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200412-1740OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Resp Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "172"
                        "paginaInicial" => "1393"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16141440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Hyperoxemia caused by resuscitation with pure oxygen may alter intracellular redox status by increasing oxidized glutathione in asphyxiated newly born infants&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Vento M"
                            1 => "Asensi M"
                            2 => "Sastre J"
                            3 => "Lloret A"
                            4 => "Garc&#237;a-Sala F"
                            5 => "Mi&#241;ana JB"
                            6 => "et al&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Perinatol"
                        "fecha" => "2002"
                        "volumen" => "26"
                        "paginaInicial" => "406"
                        "paginaFinal" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12537311"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Response to resuscitation of the newborn&#58; Early prognostic variables&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Saugstad OD"
                            1 => "Ramji S"
                            2 => "Rootwelt T"
                            3 => "Vento M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/08035250510036507"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatrica"
                        "fecha" => "2005"
                        "volumen" => "94"
                        "paginaInicial" => "890"
                        "paginaFinal" => "5"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16188811"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Tarnow-Mordi WO&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)60464-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Room air or oxygen for asphyxiated babies? Lancet"
                        "fecha" => "1998"
                        "volumen" => "352"
                        "paginaInicial" => "341"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9717918"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Robbins Levine C"
                            1 => "Davis JM&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "% oxygen:Should we change our ways? Pediatr Res"
                        "fecha" => "2001"
                        "volumen" => "50"
                        "paginaInicial" => "432"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Evaluating resuscitation practices on the basis of evidence&#58; The findings at first glance may seem illogical&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Kattwinkel J&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mpd.2003.147"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2003"
                        "volumen" => "142"
                        "paginaInicial" => "221"
                        "paginaFinal" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12640361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Oxygen toxicity at birth&#58; The pieces are put together&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Saugstad OD&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Res"
                        "fecha" => "2003"
                        "volumen" => "54"
                        "paginaInicial" => "789"
                        "itemHostRev" => array:3 [
                          "pii" => "S1130140610000616"
                          "estado" => "S300"
                          "issn" => "11301406"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "The evidence mounts against use of pure oxygen in newborn resuscitation&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Paneth N&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jpeds.2005.04.058"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2005"
                        "volumen" => "147"
                        "paginaInicial" => "4"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16027683"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:3 [
                      "titulo" => "Reevaluating neonatal resuscitation with 100 &#37; oxygen&#46;"
                      "idioma" => "en"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Martin RJ"
                            1 => "Walsh MC"
                            2 => "Carlo WA&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.2509002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Resp Crit Care Med"
                        "fecha" => "2005"
                        "volumen" => "172"
                        "paginaInicial" => "1360"
                        "paginaFinal" => "1"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16301299"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/16954033/0000006400000005/v0_201404151111/13087867/v0_201404151111/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14281"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16954033/0000006400000005/v0_201404151111/13087867/v0_201404151111/en/37v64n05a13087867pdf001.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/13087867?idApp=UINPBA00005H"
]
Información del artículo
ISSN: 16954033
Idioma original: Inglés
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Noviembre 8 7 15
2024 Octubre 37 42 79
2024 Septiembre 53 26 79
2024 Agosto 62 55 117
2024 Julio 38 31 69
2024 Junio 53 27 80
2024 Mayo 43 33 76
2024 Abril 43 28 71
2024 Marzo 42 38 80
2024 Febrero 38 40 78
2024 Enero 32 23 55
2023 Diciembre 24 14 38
2023 Noviembre 47 19 66
2023 Octubre 36 15 51
2023 Septiembre 24 21 45
2023 Agosto 27 16 43
2023 Julio 30 28 58
2023 Junio 34 20 54
2023 Mayo 34 18 52
2023 Abril 15 15 30
2023 Marzo 30 20 50
2023 Febrero 30 17 47
2023 Enero 21 21 42
2022 Diciembre 39 20 59
2022 Noviembre 61 51 112
2022 Octubre 33 36 69
2022 Septiembre 28 37 65
2022 Agosto 33 42 75
2022 Julio 19 34 53
2022 Junio 29 40 69
2022 Mayo 20 42 62
2022 Abril 36 37 73
2022 Marzo 33 40 73
2022 Febrero 35 40 75
2022 Enero 35 37 72
2021 Diciembre 21 26 47
2021 Noviembre 27 44 71
2021 Octubre 38 47 85
2021 Septiembre 27 39 66
2021 Agosto 27 36 63
2021 Julio 42 38 80
2021 Junio 34 38 72
2021 Mayo 39 18 57
2021 Abril 74 78 152
2021 Marzo 36 24 60
2021 Febrero 46 12 58
2021 Enero 33 17 50
2020 Diciembre 29 21 50
2020 Noviembre 30 5 35
2020 Octubre 20 10 30
2020 Septiembre 7 13 20
2020 Agosto 14 10 24
2020 Julio 19 10 29
2020 Junio 41 17 58
2020 Mayo 52 25 77
2020 Abril 27 15 42
2020 Marzo 23 19 42
2020 Febrero 27 24 51
2020 Enero 23 11 34
2019 Diciembre 40 19 59
2019 Noviembre 14 9 23
2019 Octubre 10 8 18
2019 Septiembre 5 10 15
2019 Agosto 23 11 34
2019 Julio 25 31 56
2019 Junio 37 12 49
2019 Mayo 25 18 43
2019 Abril 32 25 57
2019 Marzo 23 15 38
2019 Febrero 24 14 38
2019 Enero 18 15 33
2018 Diciembre 27 23 50
2018 Noviembre 34 28 62
2018 Octubre 49 20 69
2018 Septiembre 19 10 29
2018 Agosto 1 0 1
2018 Julio 6 0 6
2018 Junio 2 0 2
2018 Mayo 4 0 4
2018 Abril 16 0 16
2018 Marzo 13 0 13
2018 Febrero 11 0 11
2018 Enero 19 0 19
2017 Diciembre 16 0 16
2017 Noviembre 18 0 18
2017 Octubre 12 0 12
2017 Septiembre 15 0 15
2017 Agosto 16 0 16
2017 Julio 16 3 19
2017 Junio 21 25 46
2017 Mayo 19 24 43
2017 Abril 12 16 28
2017 Marzo 14 14 28
2017 Febrero 7 12 19
2017 Enero 9 10 19
2016 Diciembre 17 8 25
2016 Noviembre 42 5 47
2016 Octubre 29 6 35
2016 Septiembre 36 4 40
2016 Agosto 14 1 15
2016 Julio 8 2 10
2015 Diciembre 4 0 4
2015 Noviembre 1 0 1
2015 Septiembre 1 0 1
2015 Agosto 4 0 4
2015 Julio 23 6 29
2015 Junio 35 0 35
2015 Mayo 39 3 42
2015 Abril 11 3 14
2015 Marzo 31 5 36
2015 Febrero 13 5 18
2015 Enero 18 1 19
2014 Diciembre 38 3 41
2014 Noviembre 37 0 37
2014 Octubre 23 1 24
2014 Septiembre 27 3 30
2014 Agosto 45 1 46
2014 Julio 40 1 41
2014 Junio 70 2 72
2014 Mayo 70 5 75
2014 Abril 54 3 57
2014 Marzo 58 16 74
2014 Febrero 48 10 58
2014 Enero 47 15 62
2013 Diciembre 60 12 72
2013 Noviembre 62 17 79
2013 Octubre 56 14 70
2013 Septiembre 46 19 65
2013 Agosto 58 12 70
2013 Julio 47 8 55
2013 Junio 11 3 14
2013 Mayo 14 3 17
2013 Abril 13 2 15
2013 Marzo 32 5 37
2013 Febrero 24 3 27
2013 Enero 25 3 28
2012 Diciembre 26 1 27
2012 Noviembre 18 9 27
2012 Octubre 3 0 3
2012 Septiembre 4 1 5
2012 Agosto 2 1 3
2006 Abril 4332 0 4332
Mostrar todo

Siga este enlace para acceder al texto completo del artículo

Idiomas
Anales de Pediatría
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?