{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:15:19Z","timestamp":1760166919971,"version":"build-2065373602"},"reference-count":18,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T00:00:00Z","timestamp":1626220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","award":["5R01 HD072929"],"award-info":[{"award-number":["5R01 HD072929"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Neonatal resuscitation (NRP) guidelines suggest targeting 85\u201395% preductal SpO2 by 10 min after birth. Optimal oxygen saturation (SpO2) targets during resuscitation and in the post-resuscitation management of neonatal meconium aspiration syndrome (MAS) with persistent pulmonary hypertension (PPHN) remains uncertain. Our objective was to compare the time to reversal of ductal flow from fetal pattern (right-to-left), to left-to-right, and to evaluate pulmonary (QPA), carotid (QCA)and ductal (QDA) blood flows between standard (85\u201394%) and high (95\u201399%) SpO2 targets during and after resuscitation. Twelve lambs asphyxiated by endotracheal meconium instillation and cord occlusion to induce MAS and PPHN were resuscitated per NRP guidelines and were randomized to either standard (85\u201394%) or high (95\u201399%) SpO2 targets. Out of twelve lambs with MAS and PPHN, six each were randomized to standard and high SpO2 targets. Median [interquartile range] time to change in direction of blood flow across the ductus arteriosus from right-to-left, to left-to-right was significantly shorter with high SpO2 target (7.4 (4.4\u201310.8) min) compared to standard SpO2 target (31.5 (21\u201366.2) min, p = 0.03). QPA was significantly higher during the first 10 min after birth with higher SpO2 target. At 60 min after birth, the QPA, QCA and QDA were not different between the groups. To conclude, targeting SpO2 of 95\u201399% during and after resuscitation may hasten reversal of ductal flow in lambs with MAS and PPHN and transiently increase QPA but no differences were observed at 60 min. Clinical studies comparing low and high SpO2 targets assessing hemodynamics and neurodevelopmental outcomes are warranted.<\/jats:p>","DOI":"10.3390\/children8070594","type":"journal-article","created":{"date-parts":[[2021,7,14]],"date-time":"2021-07-14T10:13:42Z","timestamp":1626257622000},"page":"594","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Randomized Trial of Oxygen Saturation Targets during and after Resuscitation and Reversal of Ductal Flow in an Ovine Model of Meconium Aspiration and Pulmonary Hypertension"],"prefix":"10.3390","volume":"8","author":[{"given":"Amy L.","family":"Lesneski","sequence":"first","affiliation":[{"name":"Department of Stem Cell Research, University of California, Davis, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Payam","family":"Vali","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan E.","family":"Hardie","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6098-2155","authenticated-orcid":false,"given":"Satyan","family":"Lakshminrusimha","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6704-6949","authenticated-orcid":false,"given":"Deepika","family":"Sankaran","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, Davis, Sacramento, CA 95817, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e680","DOI":"10.1542\/neo.16-12-e680","article-title":"Persistent Pulmonary Hypertension of the Newborn","volume":"16","author":"Lakshminrusimha","year":"2015","journal-title":"Neoreviews"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"H542","DOI":"10.1152\/ajpheart.1988.254.3.H542","article-title":"Development of pulmonary vascular response to oxygen","volume":"254","author":"Morin","year":"1988","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1203\/00006450-199004000-00010","article-title":"Changes in the Pulmonary Circulation during Birth-Related Events","volume":"27","author":"Teitel","year":"1990","journal-title":"Pediatr. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/pr.2015.259","article-title":"Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration","volume":"79","author":"Rawat","year":"2016","journal-title":"Pediatr. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1165\/rcmb.2019-0449OC","article-title":"Optimal Oxygen Targets in Term Lambs with Meconium Aspiration Syndrome and Pulmonary Hypertension","volume":"63","author":"Rawat","year":"2020","journal-title":"Am. J. Respir. Cell Mol. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"R716","DOI":"10.1152\/ajpregu.00318.2018","article-title":"Antenatal betamethasone augments early rise in pulmonary perfusion at birth in preterm lambs: Role of ductal shunting and right ventricular outflow distribution","volume":"316","author":"Smolich","year":"2019","journal-title":"Am. J. Physiol. Regul. Integr. Comp. Physiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1038\/pr.2014.186","article-title":"Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration","volume":"77","author":"Lakshminrusimha","year":"2015","journal-title":"Pediatr. Res."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kilkenny, C., Browne, W.J., Cuthill, I.C., Emerson, M., and Altman, D.G. (2010). Improving bioscience research reporting: The ARRIVE guidelines for reporting animal research. PLoS Biol., 8.","DOI":"10.1371\/journal.pbio.1000412"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sankaran, D., Chandrasekharan, P.K., Gugino, S.F., Koenigsknecht, C., Helman, J., Nair, J., Mathew, B., Rawat, M., Vali, P., and Nielsen, L. (2021). Randomised trial of epinephrine dose and flush volume in term newborn lambs. Arch. Dis. Child. Fetal Neonatal Ed.","DOI":"10.1136\/archdischild-2020-321034"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sankaran, D., Vali, P., Chen, P., Lesneski, A.L., Hardie, M.E., Alhassen, Z., Wedgwood, S., Wyckoff, M.H., and Lakshminrusimha, S. (2021). Randomized trial of oxygen weaning strategies following chest compressions during neonatal resuscitation. Pediatr. Res., 1\u20139.","DOI":"10.1038\/s41390-021-01551-1"},{"key":"ref_11","unstructured":"American Academy of Pediatrics, Weiner, G.M., American Heart Association, and Zaichkin, J. (2016). Textbook of Neonatal Resuscitation, American Academy of Pediatrics. [7th ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1542\/peds.105.1.14","article-title":"Persistent pulmonary hypertension of the newborn in the era before nitric oxide: Practice variation and outcomes","volume":"105","author":"Tyson","year":"2000","journal-title":"Pediatrics"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"243","DOI":"10.3233\/NPM-16915133","article-title":"An international survey on persistent pulmonary hypertension of the newborn: A need for an evidence-based management","volume":"9","author":"Nakwan","year":"2016","journal-title":"J. Neonatal-Perinat. Med."},{"key":"ref_14","first-page":"276","article-title":"Management of Supplemental Oxygen for Infants with Persistent Pulmonary Hypertension of Newborn: A Survey","volume":"34","author":"Alapati","year":"2017","journal-title":"Am. J. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/j.jpeds.2013.04.043","article-title":"Perinatal asphyxia with hyperoxemia within the first hour of life is associated with moderate to severe hypoxic-ischemic encephalopathy","volume":"163","author":"Kapadia","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2190","DOI":"10.1001\/jama.2018.5725","article-title":"Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration","volume":"319","author":"Askie","year":"2018","journal-title":"JAMA"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1038\/jp.2014.199","article-title":"Oxygen targeting in preterm infants: A physiological interpretation","volume":"35","author":"Lakshminrusimha","year":"2015","journal-title":"J. Perinatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1203\/00006450-199410000-00015","article-title":"Surfactant therapy and high-frequency jet ventilation in the management of a piglet model of the meconium aspiration syndrome","volume":"36","author":"Wiswell","year":"1994","journal-title":"Pediatr. Res."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/7\/594\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:30:13Z","timestamp":1760164213000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/8\/7\/594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,14]]},"references-count":18,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7]]}},"alternative-id":["children8070594"],"URL":"https:\/\/doi.org\/10.3390\/children8070594","relation":{},"ISSN":["2227-9067"],"issn-type":[{"type":"electronic","value":"2227-9067"}],"subject":[],"published":{"date-parts":[[2021,7,14]]}}}