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Presented By : Dr. SUBHASIS ROY , CONSULTANT, SISU SANJIBAN HOSPITAL , SALT LAKE , KOLKATA,NEONATAL OXYGEN THERAPY,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”,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,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.,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 50 mm.Hg. n Trans cutaneous oxygen monitoring n Pulse oximetry - SpO2 85 %,MODES OF OXYGEN DELIVERY SOURCE n O2 cylinder n O2 concentrator - max 5 8 lit / min. of 90 92% O2 n Pipeline - Cheapest,MODES OF OXYGEN DELIVERY DELIVERY DEVICE LOW FLOW DEVICE n Nasal Canula Max flow 2 3 lts./min. in new born. n Nasopharyngeal Catheter Insert a length Alae nasai to Tragus Check for blockage with mucus plug FiO2 difficult to measure/control Better if changed 24 hrly. Not more than 3 lit. / min. O2 in new born Every lit. of O2 - FiO2 by 4,MODES OF OXYGEN DELIVERY HIGH FLOW DEVICE n Mask mask with 5 lit / min O2 can give 40 60% O2 require a minimum O2 flow to prevent rebreathing of CO2 n Enclosure system O2 hood - 7 lit./ min of 100% O2 required initially to wash out CO2 FiO2 can be 0.21 1. O2 given 4 lit. min. can be managed without humidifier.,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 Alarm set 85 96% SpO2 Target range 88 95% SpO2 Except PPHN SpO2 97% Unable to detect hyperoxia reliably Plenty of other limitation,WHAT TO EXPECT FROM ADEQUATE OXYGEN THERAPY n Trans centaneous O2 monitoring Not accurate in term babies with thick skin Not used in prematures 27 wks. Heat related problems skin heated to 44oc C. Invasive monitoring n ABG Gold standard 8 12 hourly may be required PaO2 50 80 mm Hg. PaO2 100 120 mm Hg acceptable in PPHN,NON RESPONDERS TO OXYGEN THERAPY CCHD - COMMONEST LARGE INTRAPULMONARY SHUNT - UNCOMMON METHAEMOGLOBINAEMIA - RARE HYPEROXIA TEST FiO2 0.21 FiO2 1.0 x 10 min NORMAL 70 (95) 200(100) CCHD 150(100),MARKERS OF O2 MONITORING PiO2 = (760 47) x 0.21 = 150 mmHg. FiO2 = 0.21 PAO2 = 100 mmHg PaO2 = 90 mmHg SaO2 O2 saturation derived from arterialised cap. Blood. SpO2 O2 saturation by puls. ox THUMB RULE: FiO2 x 5 = PaO2,UNWANTED EFFECTS OF O2 THERAPY IMMEDIATE Some neonate on hypoxic drive going to apnoea. LATE - ROP Persistent PaO2 - main contributary factor CLD Free radical damage due to O2 therapy. HIE HOME O2 DEPENDANCE AND REHOSPITALISATION NOSOCOMIAL INFECTION,EFFECTS OF NOT ENOUGH OXYGEN,n Pulm Vasc. Resistance n Airway Resistance n Risk of SIDS in Infant with CLD n ? Limitation in Growth n ? Sleep Disorder,O2 HOW COSTLY IT IS ? n COMMONLY USED SIZE F CYL. CAP 1320 lit. Refilling cost Rs. 140.00 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. Refilling cost Rs. 220.00 Institutions charge Rs. 400 800/day, irrespective of usage/ day. !,KEY POINTS,n New born Resus If O2 not available Room Air may be enough in 90% cases. To save life Do not think of ROP, Short term PaO2 acceptable. n Beyond EMERGENCY period Strict monitoring of PaO2 necessary. n To Detect ROP Eye exam from 4-6 weeks & 24 weekly in32 wk. 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.,KEY POINTS. n Keep

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