Oxygen Therapy In Infants Research Articles

Ischemic changes associated with a large patent arterial duct in small infants

Infants with a large patent arterial duct (PDA) may develop signs of congestive heart failure secondary to pulmonary overcirculation. As the PVR decreases, the relative pulmonary blood flow (Qp :Qs ) increases and this may cause tachypnea, respiratory distress, failure to thrive, ventricular dysfunction and even ventilator dependency. The diastolic runoff from the systemic circulation may result in intestinal hypoperfusion resulting in necrotizing enterocolitis, and in severe cases, myocardial ischemia. Cardiac ischemia due to coronary steal is a recognized clinical entity. We present two cases of infants who developed coronary artery steal with the use of supplemental oxygen therapy during anesthesia induction for PDA occlusion. These cases highlight the importance of prudent use of supplemental oxygen therapy in infants with large PDAs.

High-flow nasal cannula oxygen for bronchiolitis in a pediatric ward: a pilot study.

High-flow nasal cannula (HFNC) is a widely used ventilatory support in children with bronchiolitis in the intensive care setting. No data is available on HFNC use in the general pediatric ward. The aim of this study was to evaluate the feasibility of HFNC oxygen therapy in infants hospitalized in a pediatric ward for moderate–severe bronchiolitis and to assess the changes in ventilatory parameters before and after starting HFNC support. This prospective observational pilot study was carried out during the bronchiolitis season 2011–2012 in a pediatric tertiary care academic center in Italy. Interruptions of HFNC therapy and possible side effects or escalation to other forms of respiratory support were recorded. Oxygen saturation (SpO2), end-tidal carbon dioxide (ETCO2), and respiratory rate (RR), measured for a baseline period of 1 h before and at specific time intervals in 48 h after the start of HFNC were recorded. Twenty-seven infants were included (median age 1.3 months; absolute range 0.3–8.5). No adverse events, no premature HFNC therapy termination, and no escalation to other forms of respiratory support were recorded. Median SpO2 significantly increased by 1–2 points after changing from standard oxygen to HFNC (p <0.001). Median ETCO2 and RR rapidly decreased by 6–8 mmHg and 13–20 breaths per minute, respectively, in the first 3 h of HFNC therapy (p <0.001) and remained steady thereafter. Conclusions: Use of HFNC for oxygen administration is feasible for infants with moderate–severe bronchiolitis in a general pediatric ward. In these children, HFNC therapy improves oxygen saturation levels and seems to be associated with a decrease in both ETCO2 and RR.

Central sleep-disordered breathing and the effects of oxygen therapy in infants with Prader-Willi syndrome

ObjectivesTo describe breathing patterns in infants with Prader-Willi Syndrome (PWS), as well as the effects of supplemental oxygen (O2) on breathing patterns. Children with PWS commonly have sleep-disordered breathing, including...

Home oxygen therapy in infants with bronchopulmonary dysplasia: assessment of parental anxiety.

It is conceivable that a complicated recovery course in a high-risk premature infant managed at home generates apprehension and anxiety in parents. We attempted to define the evolution of anxiety levels in a population of parents of low-birth-weight premature infants with bronchopulmonary dysplasia enrolled in a prospective home O(2) therapy program. In the immediate pre-discharge [mean postnatal age 95 (45-158) days], a questionnaire (State-Trait Anxiety Inventory form Y) was given to all parents of the premature infants [mean birth weight 1106 (0.610-1.770) kg; mean gestational age 27.1 (24-31) weeks] present for the discharge. Subsequently, the parents were assessed twice, initially after a week from the discharge of their infants and then at the end of the oxygen therapy phase [mean postnatal age 185 (60-361) days]. They included 10 mothers and 10 fathers, aged 33.5+/-0.5 and 37+/-0.2 years, respectively. Our results indicate that these parents present an increased state anxiety level upon hospital discharge of their oxygen-dependent premature infants, which decreases as the improvement of respiratory status and the cessation of oxygen-dependency become evident [mean+/-S.D. related to age (T) maternal values 47.1+/-7.0, 41.8+/-5.6, 39.1+/-4.7, respectively; mean+/-S.D. related to age (T) paternal values 42.2+/-8.5, 41.1+/-8.1, 40.5+/-8.2, respectively]. When assessed separately by parental gender, in the maternal group, state anxiety decreased significantly (ANOVA, p<0.05). These data indicate that although neonatologists generally define the discharge of prematures with chronic lung disease based upon the acquired stabilization of vital parameters, in the oxygen-dependent group, they should also pay special attention to the emotional support of the parents who we have identified as being at increased risk for pre-discharge anxiety.

Home oxygen therapy in infants with bronchopulmonary dysplasia: a prospective study.

We followed the clinical course of 21 infants with bronchopulmonary dysplasia enrolled in a prospective home O2 therapy programme during a 4-year-period. Mean gestational age was 28.5 weeks (range, 25-36 weeks) and mean birth weight 1093 g (range 630-2750 g). Infants were regularly monitored to maintain pulse oximeter O2 saturation over 94%-95%. The source of O2 was liquid oxygen and was delivered by nasal cannula. During the follow up oxygenation was assessed by SatO2 measurement, cardiac function by Doppler echocardiography and respiratory function by the occlusion technique. All patients had an ophthalmological follow up. The mean age of the infants at discharge was 3.7 months (range 1.7-8.6) and mean weight 2830 g (range 2150-3780 g). At discharge 8 infants had right ventricular hypertrophy (RVH) and four of them had pulmonary hypertension. Mean duration of home O2 therapy was 97 days (range 15-320 days) and the mean age of discontinuation of O2 was 6.9 months (range 3-14.7 months). The cardiological follow up was benign: the ECG signs of RVH disappeared by 12 months of age in six out of eight infants and the right ventricular pulmonary pressure, as measured by the Doppler method, normalised in the four patients in whom it was detected. No relationship was found between respiratory mechanics and the duration of O2 therapy. Weight gain was poor with mean growth at the 3rd percentile for females and just below the 3rd percentile for males. Twelve of the 21 infants required 25 rehospitalizations. No one presented deterioration of retinopathy of prematurity that was present in 16 infants at discharge; at 12 months retinopathy was resolved in 14 infants. A total of 2025 hospital days were saved, representing a significant financial saving. Home O2 therapy permits the safe early discharge of O2-dependent BPD infants and it reduces significantly the length of time spent in hospital which represents a considerable financial saving.

Manual and home oxygen therapy for infants: a discharge planning guide

Manual and home oxygen therapy for infants: a discharge planning guide

Low flow oxygen therapy in infants.

Fifty one infants who were oxygen dependent after treatment for neonatal respiratory disease were entered into a study programme where 100% oxygen was delivered at low flow through a nasal catheter. Thirty five (69%) of the infants were discharged home and the remainder were either discharged to a convalescent hospital or back to their peripheral referring hospital. Excluding repeat admissions for monitoring or for the treatment of acute infections, 2760 hospital days (79 days/patient) were saved, representing a financial saving of $11990 (pounds 6500) per treated infant. A home low flow oxygen therapy programme has benefits to the infant/parent relationship, provides a more constant flow of oxygen than conventional methods, and the early hospital discharge represents a considerable financial saving.

Special Considerations in Oxygen Therapy for Infants and Children1–2

Special Considerations in Oxygen Therapy for Infants and Children^1–²

Bronchopulmonary dysplasia associated with oxygen therapy in infants with respiratory distress syndrome.

Sequential pathologic and radiographic events are described in 47 infants with respiratory distress syndrome who survived from 3 hr. to 23 days after initiation of intensive oxygen therapy. Bronchopulmonary dysplasia became apparent after 20 hr. of therapy and consisted of an initial exudative reaction that merged with a reparative phase. Progression of the reparative phase led to interstitial fibrosis, emphysema, and honeycomb lesions. An early radiographic feature is vacuole-like radiolucencies within the opacified lung field. Subsequently, there are cystic to bubble-like air spaces interspersed with coarsely granular and/or confluent densities that tend to gradually resolve and leave strand-like residues.

CONTINUOUS GAS ANALYSIS IN THE CONTROL OF OXYGEN THERAPY FOR INFANTS

CONTINUOUS GAS ANALYSIS IN THE CONTROL OF OXYGEN THERAPY FOR INFANTS