Hutchinson
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 |
NNT7 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 |
NNT15 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 |
NNT6 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.
