A PRELIMINARY BY HOWARD F. KANE, M.D., F.A.C.S., (E”rom tha Dqartwwnt
AND JOSEPH KREISELMAN, WASHINGTON, D. C. of Obstetrics, George Washington University)
URING the development of the apparatus for the resuscitation of the asphyxiated newborn which was described by Kreiselman, Kane and Swope in 1928, it became necessary to decide upon the relative merits of oxygen and oxygen-carbon dioxide as resuscitating agents. Acknowledging the beneficial effects of the combination of carbon dioxide with oxygen in adult asphyxia, it seemed doubtful that asphyxia neonatorum presented the same pathologic conditions or that it called for stimulation of the respiratory centers by means of carbon dioxide. In the experiments it was found that pure oxygen, instilled into the lungs, and taken up by the blood stream was sufficient to initiate respiration in all cases in which no intracranial damage had been sustained. In a few casesa combination of 5 per cent carbon dioxide and 95 per cent oxygen was employed with no difference in clinical results. With the cooperation of Drs. Oscar B. Hunter and Tomas Cajigas of t.he Department of Pathology of the George Washington University, the carbon dioxide content of the blood of forty-seven newborn infants was determined. Blood was taken from the cord which was cut as soon as possible after delivery. In order to avoid contamination of the blood by air, the cord was severed six inches from the abdomen and the end immediately submerged beneath a layer, one-half centimeter deep, of mineral oil in a small wide-mouthed bottle. This layer of oil sealed the specimen while it was being collected. Many specimens were not satisfactory due to the practical difficulty encountered in holding under the surface of the oil, a slippery cord one end of which was attached to an actively moving infant. Frequently, too, only one or two cubic centimeters could be obtained before the bleeding stopped. The forty-seven specimens examined were divided into three groups: (1) blood from babies deep in asphyxia; (2) from babies who gasped once or twice during the collection of the blood ; (3) from babies who were born crying. In group (2) it was frequently impossible to determine whether or not air was being drawn into the lungs, but it may be inferred that some babies succeeded in partially aerating the lungs as the carbon dioxide content in this group was found to be between the
two. The occasional wide variations within the groups due to faulty technic in collecting the specimens. QBOUP 1 ASPHYXIAmD 1. 53.0 2. 59.0 3. 40.4 4. 59.8 5. 66.4 6. 63.0 7. 40.5 Average
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26.
51.0 51.9 47.0 51.0 41.4 43.4 42.4 51.0 42.4 48.7 49.0 50.0 48.0 46.2 43.3 43.3 43.8 43.3 48.0 50.4 39.0 52.8 46.0 56.7 46.2 55.7
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
34.4 40.0 46.2 42.0 34.7 48.5 42.4 49.0 53.0 54.0 57.0 41.0 54.0 32.4
From this small number of eases it would seem that the carbon dioxide content of the blood in the newborn is consistently high ; that the proportion of carbon dioxide increases with the degree of asphyxia; and, therefore, that the addition of carbon dioxide to oxygen as a resuscitating agent is contraindicated. REFERENCE
Ereiselman, Resuscitation 1928. 1835
J., Kane, of
Swope, R. B.: A New Babies, AM. J. OBST.
Apparatus & GYNEC.
for the 15: 552,