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.

This content is only available via PDF.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.