Dr. SUBHASIS ROY ,

1
NEONATAL OXYGEN THERAPY
Presented By Dr. SUBHASIS ROY , CONSULTANT,
SISU SANJIBAN HOSPITAL , SALT LAKE , KOLKATA
2
THE HISTORY
1774 J. Priestly produced O2
Dephlogisticated Air 1776 A. L. Lavoisier
termed this vital air OXYGEN Late 1800
Bonnaire gave O2 to preterm Blue Baby

with success . 1907 A. Lane invented
NASAL CATHETER 1919 L. Hill developed O2
TENT. 1920 - O2 therapy became routine for SICK
NEW BORN
3
O2 THERAPY IN NEONATE VS OLDER CHILDREN    In
Neonate   n O2 reserve less n O2
requirement / kg. higher. n Small change in Fi
O2 large change in Pa O2 n Unrestricted O2
therapy produce pulmonary / extra pulmonary
hazards.  MORE CAUTION REQUIRED IN NEONATAL O2
THERAPY
4
NEW BORN RESUSCITATION HOW IMPORTANT O2 IS
CURRENT RECOMMENDATION 100 O2 IN NRP BUT A
GROWING OPINION THAT RA CAN BE USED IN PLACE OF
O2 Approx 100 million babies born annually,
globally - 10 million need resus ! . Cochrane
review RAR group shorter time to first breath
and first cry. RAR group only 25 required
100 backup O2 facility. RAR group Marginally
lower overall mortality. No evidence of HARM in
using RA BUT INSUFFICIENT DATA TO RECOMMEND
RA OVER 100 O2 NEW BORN RESUS. IS A SCIENTIFIC
PROTOCOL BUT MORE AN ART THAN A SCIENCE IN
DEVELOPING COUNTRIES WITH RESOURCE CONSTRAINTS.
NOT TO PANIC IF O2 SUPPLY IN LABOUR ROOM IS
RESTRICTED OR NOT AVAILABLE.
5
ASSESSMENT OF NEED OF O2 THERAPY  DURING AND JUST
AFTER RESUSCITATION IN NEWBORN Only clinical
n Cyanosis n Heart rate i.e
bradycardia n Resp effort n
Muscle tone n Response to
stimuli  LATER PART OF THE NEW BORN
LIFE  Clinical n Cyanosis   n
Heart rate   n Pattern of breathing
i.e. apnoea/Periodic breathing Monitoring -
n ABG PaO2 lt 50 mm.Hg.   n Trans
cutaneous oxygen monitoring   n Pulse
oximetry - SpO2 lt 85
6
MODES OF OXYGEN DELIVERY   SOURCE n O2
cylinder   n O2 concentrator - max 5 8 lit /
min. of
90 92 O2          n
Pipeline - Cheapest  
7
MODES OF OXYGEN DELIVERY DELIVERY DEVICE
LOW FLOW DEVICE   n Nasal Canula Max flow 2 3
lts./min.
in new born. n Nasopharyngeal Catheter
Ø Insert a length Alae nasai to Tragus
Ø Check for blockage with mucus plug
Ø FiO2 difficult to measure/control
Ø Better if changed 24 hrly. Ø Not
more than 3 lit. / min. O2 in new born
Ø Every lit. of O2 - ? FiO2 by 4
8
MODES OF OXYGEN DELIVERY HIGH FLOW DEVICE   n
Mask Ø mask with 5 lit / min O2 can give 40
60 O2 Ø require a minimum O2 flow to prevent
rebreathing
of CO2   n Enclosure
system Ø O2 hood - gt 7 lit./ min of 100 O2
required initially to wash out
CO2   Ø FiO2 can be 0.21 1. O2 given lt 4
lit. min. can be managed without humidifier.
9
WHAT TO EXPECT FROM ADEQUATE OXYGEN THERAPY  A.
Clinical Monitoring   n No cyanosis n No
apnoea or periodic breathing   n Stable heart
rate  B. Non Invasive Monitoring n Pulse
Oximetry   Ø Alarm set 85 96 SpO2 Ø
Target range 88 95 SpO2 Except PPHN è
SpO2 gt97 Ø Unable to detect hyperoxia
reliably Ø Plenty of other limitation
10
WHAT TO EXPECT FROM ADEQUATE OXYGEN THERAPY..
n Trans centaneous O2 monitoring   Ø Not
accurate in term babies with thick skin Ø Not
used in prematures lt 27 wks. Ø Heat related
problems skin heated to 44oc  C. Invasive
monitoring   n ABG Ø Gold standard Ø 8
12 hourly may be required Ø PaO2 50
80 mm Hg.   Ø PaO2 100 120 mm Hg
acceptable in PPHN
11

• NON RESPONDERS TO OXYGEN THERAPY
• CCHD - COMMONEST
• LARGE INTRAPULMONARY SHUNT - UNCOMMON
• Ø METHAEMOGLOBINAEMIA - RARE
• HYPEROXIA TEST
• FiO2 0.21 FiO2 1.0 x 10 min
• NORMAL 70 (95) gt200(100)
• CCHD lt40 (lt75) lt70(lt85)
• PULMONARY 50 (85) gt150(100)

12
MARKERS OF O2 MONITORING Ø PiO2 (760 47)
x 0.21 150 mmHg. Ø FiO2 0.21 Ø PAO2
100 mmHg Ø PaO2 90 mmHg Ø SaO2 O2
saturation derived from arterialised cap.
Blood. Ø SpO2 O2 saturation by puls. ox
THUMB RULE FiO2 x 5 PaO2
13
(No Transcript)
14
UNWANTED EFFECTS OF O2 THERAPY IMMEDIATE Some
neonate on hypoxic drive going to apnoea. LATE -
Ø ROP Persistent ? PaO2 - main contributary
factor Ø CLD Free radical damage due to
O2 therapy. Ø HIE Ø HOME O2 DEPENDANCE AND
REHOSPITALISATION Ø NOSOCOMIAL INFECTION

15
EFFECTS OF NOT ENOUGH OXYGEN
n é Pulm Vasc. Resistance n é Airway Resistance
n é Risk of SIDS in Infant with CLD n ?
Limitation in Growth n ? Sleep Disorder
16

• O2 HOW COSTLY IT IS ?
• n COMMONLY USED SIZE F CYL. CAP 1320 lit.
• Ø Refilling cost Rs. 140.00
• Ø 5 lit./ min. 300 lit./ hr. 4.5 hr. / CYL.
  6 CYL./day Rs. 800.00 (approx) , without
  making any profit
• n PIPED O2 CYL. USED CAP 7100 7500 lit.
• Ø Refilling cost Rs. 220.00
• Ø Institutions charge Rs. 400 800/day,
  irrespective of usage/ day. !

17
KEY POINTS
n New born Resus Ø If O2 not available Room
Air may be enough in 90 cases. Ø To save life
Do not think of ROP, Short term é PaO2
acceptable. n Beyond EMERGENCY period Ø
Strict monitoring of PaO2 necessary. n To
Detect ROP Eye exam from 4-6 weeks 24 weekly
inlt32 wk. lt 1250 gm. n Max O2 flow
through nasal catheter - do not exceed 3 lit./
min. n O2 hood initial flow of 7 lit./ min.
required.
18

• KEY POINTS.
• n Keep PaO2 50 80 mm. Hg. , SpO2 88 - 95
• n O2 is a DRUG only should be used Ø Documented
  hypoxia
• Ø Resp. Distress
• Ø Cynosis
• n When prescribing O2 specify - Ø Dose
• Ø Device
• Ø Duration
• Ø Monitoring
• n Take care of devices judiciously to prevent
  NOS. INFECTION

19
THANK YOU