Hyperbaric
oxygenation or intubation and ventilation produced similar neonatal outcomes for
apnoeic neonates.
Clinical Bottom Line:
1.
The administration of hyperbaric oxygenation did not produce better neonatal
outcomes than intubation and ventilation.
2.
There was no treatment preference in a stratified analysis of premature versus
mature neonates.
Appraised
by: Mike Bennett, Dept of Diving and
Hyperbaric Medicine, Prince of Wales Hospital, Sydney. Thursday, 03 December,
1998.
Clinical
Scenario: A neonate who failed to
establish adequate respiration within three minutes of birth despite
nasotracheal suction and oxygen by funnel.
Three-part
Question: In the newborn, does the
application of hyperbaric oxygenation, compared to tracheal intubation and
positive pressure ventilation, result in any improvement in neonatal outcome?
Search
Terms: Hyperbaric oxygenation,
asphyxia neonatorum.
The
Study:
Non-blinded randomised
controlled trial without intention-to-treat.
Neonates apnoeic or breathing
ineffectively at three minutes post-delivery.
Control group (N = 111; 111
analysed): Tracheal intubation at three minutes by trained staff, followed by
positive pressure ventilation.
Experimental group (N = 107; 107
analysed): Application of hyperbaric oxygen. Details unclear, but maximum 4 ATA
for 30 minutes.
The
Evidence:
|
Outcome |
Time
to Outcome |
Intubation
group rate |
HBO
group rate |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Death |
? |
0.135 |
0.178 |
32% |
0.04 |
23 |
|
95%
CI: |
|
|
|
-40%
to 100% |
-0.05
to 0.14 |
NNT=7
to INF NNH=19 to
INF |
|
Death
in mature babies |
? |
0.036 |
0.009 |
75% |
0.03 |
37 |
|
95%
CI: |
|
|
|
-33%
to 100% |
-0.01
to 0.07 |
NNT=15
to INF NNH=83 to
INF |
|
Death
in premature babies |
? |
0.099 |
0.168 |
70% |
0.07 |
14 |
|
95%
CI: |
|
|
|
-21%
to 100% |
-0.02
to 0.16 |
NNT=6
to INF NNH=48 to
INF |
Comments:
1. Old trial and resuscitation
practices are likely to have improved. Intubation skills are now more likely to
be available than hyperbaric oxygenation.
2. Randomization by day rather
than individual may have influenced results.
3. These figures are a combined
result from two hospitals with significantly different mortality rates.
4. Probably of little clinical
relevance today.
Expiry
date: December 2004
References:
1.Hutchinson JH, Kerr MM, Inall JA,
Shanks RA. Controlled trials of hyperbaric oxygen and tracheal intubation in
asphyxia neonatorum. Lancet 1966; 7444:935-939.
