Indications of oxygen therapy

The clinical situation has to be kept in mind. A newborn with congenital cyanotic heart disease may not benefit by oxygen supplementation. Hypoxemia (O2 saturation <87% and / or PaO2<50 mmHg in room air) is the single most important indication for use of oxygen in neonates. Optimal use of oxygen in neonates is essential for maximizing short or long-term growth and development, while minimizing harmful effects.
• Other indications for use of oxygen in neonates include spontaneous pneumothorax and pneumomediastinum.Administration of 100% oxygen causes absorption of nitrogen from the pleural/ mediastinal air, which is then absorbed in the circulation. Such a modality should not be tried beyond 12-16 hours to avoid oxygen toxicity.
Apnea: Use of oxygen is widely practiced in babies with apnea. Oxygen helps in improving the CO2 sensitivity by the brain in preterm neonates; however one needs to avoid Hyperoxia. Shock and Heart disease: Oxygen in these situations of reduced cardiac output would help in higher alveolar oxygen and thereby increasing the arterial oxygen content of the blood and improved tissue delivery. Chronic lung disease: The babies need low or minimal oxygen so as to maintain saturations between 90-95%.
Supplemental oxygen must always be monitored. In Level III NICU there should be facilities for ABG analysis and Pulse-oximetry. There is enough evidence that unmonitored and unrestricted us of oxygen in neonates has potential harm without any clear benefits. There is no need to start all babies especially with respiratory distress with oxygen. The only indication for use of oxygen in neonates is hypoxia.
  • Introduction...
  • 1. Overview...
  • 2. Indication for ...
  • 3. Indications...
  • 4. Rationale of ox...
  • 5. Carry home mess...
 

Introduction

DR. SANDEEP KADAM
MD, DM (Neonatology)

Associate Consultant Neonatologist
Department of Pediatrics
KEM Hospital
Pune

1. Overview

â–º Oxygen is the most common and abundantly used drug
    in NICU

â–º Deliver adequate amount of oxygen to avoid oxygen
    toxicity

â–º Use oxygen judiciously and correctly

â–º Goal is to avoid both hypoxia and hyperoxia

2. Indication for oxygen therapy

â–º Hypoxia (SpO2 < 90%): most important indication

â–º Clinical situation of a neonate

3. Indications

â–º In neonates, supplemental O2 is indicated,
    if SpO2 is < 90%

â–º ABG facility
      ♦ Preterm babies: PaO2 is < 50 mm Hg

4. Rationale of oxygen therapy

â–º Avoid routine use of oxygen in
      ♦ Respiratory distress
      ♦ Apnea
      ♦ Shock

â–º Always monitor saturations and give only if saturation is
    below 90% or is unrecordable

5. Carry home message

â–º Monitor supplemental oxygen once started

â–º Facility of ABG & pulse oximeter is must in NICU

â–º Unrestricted and unlimited use of oxygen therapy is
    associated with dire consequences

â–º Most important indication of oxygen therapy is Hypoxia