Management of Supplemental Oxygen for Infants with Persistent Pulmonary Hypertension of Newborn: A Survey

Abstract

Objective To evaluate practice variations amongst neonatologists regarding oxygen management in neonates with persistent pulmonary hypertension of newborn (PPHN). Study Design An online survey was administered to neonatologists to assess goal oxygenation targets and oxygen titration practices in PPHN. Response variations were assessed and intergroup comparisons performed. Results Thirty-three percent (492) of neonatologists completed the survey. Twenty-eight percent reported using specific oxygen titration guidelines. Majority of respondents used a combination of oxygen saturation (SpO2) and arterial oxygen tension (PaO2) initially to titrate oxygen. Seventy percent of the respondents used higher goal SpO2 > 95% or 95 to 98% and thirty-eight percent of the respondents used PaO2 > 80 mm Hg. Physicians with extracorporeal membrane oxygenation experience and those with greater than ten years neonatal intensive care unit experience inclined toward use of SpO2 alone for oxygen titration and aimed for lower range of SpO2 and PaO2 targets. Greater proportion of neonatologists who employed specific oxygen titration guidelines used lower SpO2 targets. Conclusion Wide practice variations exist amongst neonatologists regarding optimal SpO2 and PaO2 targets and oxygen titration practices in the management of PPHN.

Occurrence of hyperoxia during iNO treatment for persistent pulmonary hypertension of the newborn: a cohort study

“…In line with this, we found longer time periods of SpO 2 > 98% compared to SpO 2 < 92% within this study, indicating that the neonatologists were attentive in preventing hypoxemia but were permissive of hyperoxemia. These findings are consistent with a previous survey among 492 neonatologists in the USA that evaluated oxygen management in infants with PPHN [ 23 ]. The survey demonstrated that a significant number of neonatologists preferred to target higher SpO 2 and/or PaO 2 to avoid hypoxemia but did not use an upper limit of SpO 2 and PaO 2 to prevent hyperoxemia.…”

“…The survey demonstrated that a significant number of neonatologists preferred to target higher SpO 2 and/or PaO 2 to avoid hypoxemia but did not use an upper limit of SpO 2 and PaO 2 to prevent hyperoxemia. Furthermore, a small but notable portion of neonatologists (6%) opted to administer 100% oxygen, irrespective of the oxygenation parameters, until they were confident that the infant had clinically stabilized [ 23 ]. The permissive attitude towards hyperoxemia is also reflected by the current significant variations in practice with respect to oxygen titration strategies and the lack of evidence-based guidelines for oxygen weaning in the management of PPHN [ 23 , 24 ].…”

The Fetus Can Teach Us: Oxygen and the Pulmonary Vasculature

“…A recent survey of neonatologist (492/1500 or 33% response rate) working in level 3 or 4 neonatal intensive care units (NICUs) across the USA evaluating oxygen management in neonates with PPHN has shown wide practice variations regarding the optimal oxyhemoglobin saturation or oxygen tension targets [ 58 ]. Seventy percent (70%) of respondents chose capillary SO 2 targets > 95%, and 11% aimed to achieve arterial PO 2 > 120 mm Hg, while as many as 6% preferred to treat with 100% oxygen until they were confident that the pulmonary vascular reactivity had stabilized and did not wean FIO 2 despite SO 2 of 100%.…”

Management of neonatal pulmonary hypertension-a survey of neonatal intensive care units in India

“…The survey responses of Nakwan et al showed similar target values [7]. However, Alapati et al in their US based survey noted that two-third of their respondents used higher saturation target > 95% and almost half targeted PaO2 > 80 mmHg, thus indicating wide variability in protocols for oxygen titration across the world [13].…”