Urvi Jhaveri Sanghvi , William E. King , Colm P. Travers , Vivek V. Shukla , Robert L. Schelonka , Namasivayam Ambalavanan , Waldemar A. Carlo , Clyde Wright
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引用次数: 0
Abstract
The preterm newborn is susceptible to many diseases related to oxidative stress, and supplemental oxygen therapy and its interaction with inflammatory processes may be a contributing factor to their underlying pathophysiology. Supplemental oxygen therapy can lead to over-oxygenation, and can complicate ischemia–reperfusion processes, which in turn can promote oxidative stress pathways. We hypothesize that the optimal dose of supplemental oxygen therapy likely varies for each preterm infant based on their unique and developing physiology, and may be adjusted through the assessment autonomic nervous function and pulmonary resilience by measuring heart rate variability. We present preliminary findings demonstrating that among extremely preterm infants with low-to-moderate heart rate characteristics index (HRCi) scores (indicating healthy ANS function) during the first six postnatal days, exposure to a low target oxygen saturation range was associated with decreased risk of the composite outcome of death by 36 weeks postmenstrual age (PMA), necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and/or retinopathy of prematurity (ROP). This suggests a novel therapeutic approach to supplemental oxygen delivery in the neonatal intensive care unit (NICU) wherein the HRCi can be leveraged to guide the prescription of individualized target oxygen saturation ranges that are responsive to each infant’s unique and dynamic physiology, minimizing the risks of morbidity and mortality.
期刊介绍:
Medical Hypotheses is a forum for ideas in medicine and related biomedical sciences. It will publish interesting and important theoretical papers that foster the diversity and debate upon which the scientific process thrives. The Aims and Scope of Medical Hypotheses are no different now from what was proposed by the founder of the journal, the late Dr David Horrobin. In his introduction to the first issue of the Journal, he asks ''what sorts of papers will be published in Medical Hypotheses? and goes on to answer ''Medical Hypotheses will publish papers which describe theories, ideas which have a great deal of observational support and some hypotheses where experimental support is yet fragmentary''. (Horrobin DF, 1975 Ideas in Biomedical Science: Reasons for the foundation of Medical Hypotheses. Medical Hypotheses Volume 1, Issue 1, January-February 1975, Pages 1-2.). Medical Hypotheses was therefore launched, and still exists today, to give novel, radical new ideas and speculations in medicine open-minded consideration, opening the field to radical hypotheses which would be rejected by most conventional journals. Papers in Medical Hypotheses take a standard scientific form in terms of style, structure and referencing. The journal therefore constitutes a bridge between cutting-edge theory and the mainstream of medical and scientific communication, which ideas must eventually enter if they are to be critiqued and tested against observations.