Journal article
Impact of Oxygen Saturation Targets and Oxygen Therapy during the Transport of Neonates with Clinically Suspected Congenital Heart Disease
Neonatology (Basel, Switzerland), Vol.97(2), pp.154-162
02/2010
DOI: 10.1159/000239769
PMID: 19776649
Abstract
Background: Although guidelines for mechanical ventilation, cardiovascular support and intravenous prostaglandin are well established, there is a lack of consensus regarding SpO2 targets and safety of oxygen administration during transport of neonates with suspected congenital heart disease (CHD). In many centers, an SpO2 range of 75–85% is targeted but there is no published evidence of the clinical consequences of this approach. Objective: To determine the effect of average SpO2 range and oxygen administration during neonatal transport on clinical markers of cardiovascular instability. Methods: A retrospective study was conducted on neonates with suspected CHD who presented at community hospitals. Based on average SpO2 during transport, neonates were categorized into three distinct groups: group I (SpO2 <75%), group II (SpO2 75–85%), group III (SpO2 >85%). The severity and proportion of neonates with hypoxemia, metabolic and lactic acidosis on arrival at level III NICU were compared. A comparison was also made between oxygen requirement and indicators of cardiorespiratory instability. Results: Seventy-five neonates were studied and 14 (19%), 38 (50%) and 23 (31%) neonates were allocated to groups I, II and III, respectively. Therapeutic interventions during the transport stabilization process included oxygen (n = 53, 71%), mechanical ventilation (n = 56, 75%) and prostaglandin E1 (n = 63, 84%). The severity or proportion of neonates with hypoxemia, elevated lactate or metabolic acidosis was similar between the groups. Neonates receiving an oxygen requirement of FiO2 >70% had lower arterial SpO2 on arrival. A provisional diagnosis of CHD and/or PPHN (p = 0.01) and neonates receiving inotropes (p = 0.005) were independent risk factors for cardiovascular instability. Conclusion: If congenital heart disease is strongly suspected oxygen should be cautiously weaned to maintain a minimum SpO2 >75%. Neonates receiving >70% oxygen are at greatest risk of metabolic acidosis or critical hypoxemia and may benefit from expedited transfer to a cardiac center.
Details
- Title: Subtitle
- Impact of Oxygen Saturation Targets and Oxygen Therapy during the Transport of Neonates with Clinically Suspected Congenital Heart Disease
- Creators
- Sandesh ShivanandaJoel KirshHilary E WhyteKoshy MuthalallyPatrick J McNamara
- Resource Type
- Journal article
- Publication Details
- Neonatology (Basel, Switzerland), Vol.97(2), pp.154-162
- DOI
- 10.1159/000239769
- PMID
- 19776649
- ISSN
- 1661-7800
- eISSN
- 1661-7819
- Number of pages
- 9
- Language
- English
- Date published
- 02/2010
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology; Internal Medicine
- Record Identifier
- 9984093225402771
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