Abstract
Background:
We compared the current guidelines for neonatal resuscitation with alternative measures and aimed to find out whether this modulated brain inflammation.
Methods:
Progressive asphyxia was induced in 94 newborn pigs until asystole. With the reference being resuscitation guidelines, 30 s of initial positive-pressure ventilation before compression (C) and ventilation (V) (C:V; 3:1) in 21% oxygen, pigs were randomized to (i) ventilation for 30, 60, or 90 s before chest compressions; (ii) C:V ratios of 3:1, 9:3, or 15:2; or (iii) 21% or 100% oxygen. Concentrations of inflammatory markers in the cerebrospinal fluid (CSF) and gene expression in the hippocampus and frontal cortex were measured for different interventions.
Results:
In CSF, S100 was higher with 90 s than with 30 or 60 s of initial positive-pressure ventilation, whereas concentrations of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were higher with 30 than with 60 s. Matrix metalloproteinase-2 (MMP-2) and intracellular adhesion molecule 1 (ICAM-1) were higher with 30 than with 60 s. No other comparison between ratios and oxygen concentrations used yielded significant results.
Conclusion:
With respect to signs of brain inflammation, newly born pigs at asystole should be ventilated for longer than 30 s before chest compressions start. C:V ratios of 9:3 and 15:2 as compared with 3:1, or air instead of pure oxygen, did not modulate inflammatory markers.
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Acknowledgements
Geir Aamodt and Bettina Kulle Andreassen are specifically thanked for important and valuable statistical help and valuable suggestions, and Grete Dyrhaug and Monica Atneosen-Åsegg for optimizing the qPCR results.
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Dannevig, I., Solevåg, A., Sonerud, T. et al. Brain inflammation induced by severe asphyxia in newborn pigs and the impact of alternative resuscitation strategies on the newborn central nervous system. Pediatr Res 73, 163–170 (2013). https://doi.org/10.1038/pr.2012.167
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DOI: https://doi.org/10.1038/pr.2012.167
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