Oxygenation Practices in Pre-Term Infants, Research Paper Example

Abstract

In today’s neonatal hospital units, the administration of oxygen to neonatal infants or the period of time covering the first twenty-eight days after birth and those born pre-term or prematurely, is one of the most common practices and is usually needed for the prevention of hypoxia or the lack of cellular oxygen which often results from being born premature. However, in pre-term infants, exposure to oxygen should be limited, due to the fact that high levels of oxygen poses a threat to the health of the infant. There are basically four types of methods for administering oxygen to pre-term infants–the oxygen hood, nasal canula, nasal CPAP system, and the traditional breathing apparatus or ventilator. The most common method utilized in the past (and still in use today) is conventional mechanical ventilation (CMV), but this method is somewhat outdated, due to new advances in mechanical breathing apparatuses. Currently, most neonatal hospital units utilize what is known as high frequency oscillation (HFO) which is mostly used for pre-term infants at risk for lung disease and damage. The use of this machine is now common practice in today’s advanced neonatal hospital units, but advances in technology will eventually replace it in order to help protect delicate and sensitive pre-term infant lungs from damage and illnesses.

Oxygenation Practices in Pre-Term Infants

According to A. Sola, Y.P. Sadeno, and V. Favareto, the administration of oxygen to neonatal infants or the period of time covering the first twenty-eight days after birth and those born pre-term or prematurely is one of the most common practices in today’s neonatal hospital units. Many times, the administration of oxygen (O) to pre-term infants is a “necessary objective for the prevention of hypoxia” or the lack of cellular oxygen which results from being pre-term or premature. Some of the tissues that are most prone to hypoxia includes the brain, heart, pulmonary vessels in the lungs, and the liver (2008, p. 28).

Sola, Sadeno, and Favareto also point out that “unnecessary, even brief, neonatal exposure to oxygen when not indicated must be limited, if not avoided,” due to the fact that extremely high levels of oxygen or readings greater than 95% “in oxygen saturation monitors are potentially dangerous” (2008, p. 28). Therefore, in order to prevent hypoxia and other unwanted and potentially life-threatening conditions, specific past and present practices related to administering oxygen to pre-term infants must ideally be replaced by more efficient and safer methodologies.

J.M. Adams in “Oxygen Monitoring and Therapy in the Newborn” adds much supporting evidence by noting that the administration of oxygen is an “important component for the intensive care of the newborn” and that vigilant monitoring of oxygen saturation levels is “required to minimize pulmonary toxicity” and to lower the chances of the development of hypoxia and hyperoxia or a condition of abnormally high oxygen tension in the blood. In contrast, “excessively low oxygen saturation may be associated with increased mortality” and the risk of neurodevelopmental impairment or damage to the brain and the central nervous system (2013).

In today’s neonatal units, there are basically four types of methods for administering oxygen to pre-term infants. First of all, there is the oxygen hood, a plastic dome or square box that is placed over the infant’s head, which is primarily utilized for pre-term infants that can breathe independently yet still require some support. Secondly, rather than utilizing an oxygen hood, a “thin, soft, plastic tube called a nasal cannula” is inserted into the nostrils of the infant, much like giving oxygen to an adult with breathing problems. However, this method requires that the infant is able to breath on its own without any other kind of support (Lee, 2011).

A third method is known as a nasal CPAP system or continuous positive airway pressure. Unlike the oxygen hood or tent, this method is utilized for pre-term infants that require additional breathing support outside of a conventional oxygen ventilation machine. Technically, this system “delivers oxygen through tubes with soft nasal prongs,” and due to the oxygen being highly pressurized, the lungs are able to expand more efficiently. The fourth system is the traditional breathing apparatus or ventilator which is utilized to administer an increase in oxygen which travels through a tube inserted into the infant’s throat. This last method is often restricted or only used when the pre-term infant is totally unable to breath independently because of lung weakness (Lee, 2011).

More specifically, the most common method utilized in the past (and still in use today in many hospitals) is conventional mechanical ventilation (CMV) which fills the lungs with a “measured amount of gas at a certain rate,” much like normal breathing via inhalation and exhalation. Also, the amount or volume of pressurized oxygen can be controlled and adjusted to accommodate the specific breathing requirements of the pre-term infant (James & Belik, 2009). However, this method is somewhat outdated, due to new advances in mechanical breathing apparatuses that allow more control; thus, under most circumstances, the traditional mechanical ventilator is only utilized as a back-up system, meaning that it is “used to support breathing rather than replace it” (James & Belik, 2009).

In contrast to the conventional mechanical ventilator, most neonatal hospital units now utilize what is known as high frequency oscillation (HFO) and/or high frequency jet ventilation (HFJV). The first method achieves “gas exchange without using pushes from a ventilator” and is mostly used for pre-term infants that are “at risk for developing significant lung disease and damage. One distinct advantage of this newer system is that it helps to significantly reduce stress and stretching within the lungs; however, some pre-term infants become wholly dependent of this system and must be weaned off by slowly decreasing the volume of oxygen (James & Belik, 2009).

The second method is mechanically similar to the HFO system but instead utilizes a device that delivers tiny puffs of air into the pre-term infant’s lungs. Technically, this system provides a “steady, continuous flow of gas that is interrupted very frequently by pulsatile jets of gas directed at right angles to the continuous flow of gas.” Also, this advanced oxygenation process is normally utilized for pre-term infants with pulmonary interstitial emphysema which can often be exacerbated via the use of a conventional mechanical ventilator (James & Belik, 2009).

Overall, the use of either high frequency oscillation and/or high frequency jet ventilation is a common practice in today’s advanced neonatal hospital units. But with advances in technology, these two systems will be replaced by other systems designed to help protect delicate and sensitive pre-term infant lungs from damage and illnesses that can lead to dire consequences.

References

Adams, J.M. (2013). Oxygen monitoring and therapy in the newborn. Retrieved from http://www.uptodate.com/contents/oxygen-monitoring-and-therapy-in-the-newborn

James, A., and Belik, J. (2009). Mechanical ventilation and supplemental oxygen. Retrieved from http://www.aboutkidshealth.ca/En/ResourceCentres/PrematureBabies/OverviewofTreatment/TreatmentofBreathingProblems/Pages/Mechanical-Ventilation-and-Supplemental-Oxygen.aspx

Lee, K.G. (2011). Oxygen therapy–Infants. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007242.htm

Sola, A., Sadeno, Y.P., and Favareto, V. (2008). Clinical practices in neonatal oxygenation: Where have we failed? What can we do? Journal of Perinatology. Retrieved from http://www.nature.com/jp/journal/v28/n1s/full/jp200847a.html