Noninvasive oxygen delivery and oxygen monitoring in the newborn
- Richard Martin, MD
Richard Martin, MD
- Section Editor — Neonatology
- Professor, Pediatrics, Reproductive Biology, and Physiology & Biophysics
- Case Western Reserve University School of Medicine
- Kathleen M Deakins, MHSA RRT NPS FAARC
Kathleen M Deakins, MHSA RRT NPS FAARC
- Clinical Manager Women's & Children's Respiratory Care, Pediatric Pulmonary Function & Infant Monito
Oxygen supplementation using noninvasive measures is an important component of intensive care of the newborn. Careful monitoring is required to minimize pulmonary toxicity or the consequences of hypoxemia or hyperoxia.
Noninvasive oxygen administration and monitoring for the neonate, including the preterm infant, will be reviewed here. Oxygen administration during neonatal resuscitation in the delivery room and neonatal mechanical ventilation are discussed separately. (See "Neonatal resuscitation in the delivery room", section on 'Supplemental oxygen' and "Mechanical ventilation in neonates".)
OXYGEN DELIVERY MODALITIES
Neonatal resuscitation — The use of supplemental oxygen and its administration and monitoring are discussed separately. (See "Neonatal resuscitation in the delivery room", section on 'Supplemental oxygen'.)
Postresuscitation — Oxygen delivery devices used in the neonatal intensive care unit (NICU) and step down units include nasal cannula, nasal continuous positive airway pressure (nCPAP), nasal intermittent positive pressure ventilation (NIPPV), or endotracheal tube if the infant requires assisted ventilation. Typically, hoods and face masks are not initially used to deliver oxygen in the neonate. These devices should provide warmed and humidified gas that is delivered using a system in which the concentration can be regulated. The inspired oxygen concentration should be monitored with an oxygen analyzer, frequently or continuously if possible.
Nasal cannula — A nasal cannula provides oxygen through two soft prongs that are inserted into the patient's anterior nares. Both low- and high-flow oxygen delivery may be delivered by nasal cannula. Oxygen flows from the cannula into the patient's nasopharynx and mixes with room air entering from the infant's mouth and nose. Consequently, the concentration of oxygen that can be delivered by these methods vary depending upon factors such as the patient's respiratory rate, tidal volume, oxygen flow rate, and extent of mouth breathing.
- Benaron DA, Benitz WE. Maximizing the stability of oxygen delivered via nasal cannula. Arch Pediatr Adolesc Med 1994; 148:294.
- Walsh M, Engle W, Laptook A, et al. Oxygen delivery through nasal cannulae to preterm infants: can practice be improved? Pediatrics 2005; 116:857.
- Finer NN, Mannino FL. High-flow nasal cannula: a kinder, gentler CPAP? J Pediatr 2009; 154:160.
- Shoemaker MT, Pierce MR, Yoder BA, DiGeronimo RJ. High flow nasal cannula versus nasal CPAP for neonatal respiratory disease: a retrospective study. J Perinatol 2007; 27:85.
- Cummings JJ, Polin RA, Committee on Fetus and Newborn, American Academy of Pediatrics. Noninvasive Respiratory Support. Pediatrics 2016; 137.
- Roberts CT, Owen LS, Manley BJ, et al. Nasal High-Flow Therapy for Primary Respiratory Support in Preterm Infants. N Engl J Med 2016; 375:1142.
- Kotecha SJ, Adappa R, Gupta N, et al. Safety and Efficacy of High-Flow Nasal Cannula Therapy in Preterm Infants: A Meta-analysis. Pediatrics 2015; 136:542.
- Wilkinson D, Andersen C, O'Donnell CP, et al. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev 2016; 2:CD006405.
- Collins CL, Barfield C, Horne RS, Davis PG. A comparison of nasal trauma in preterm infants extubated to either heated humidified high-flow nasal cannulae or nasal continuous positive airway pressure. Eur J Pediatr 2014; 173:181.
- Verder H, Albertsen P, Ebbesen F, et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation. Pediatrics 1999; 103:E24.
- Van Marter LJ, Allred EN, Pagano M, et al. Do clinical markers of barotrauma and oxygen toxicity explain interhospital variation in rates of chronic lung disease? The Neonatology Committee for the Developmental Network. Pediatrics 2000; 105:1194.
- Aly H, Milner JD, Patel K, El-Mohandes AA. Does the experience with the use of nasal continuous positive airway pressure improve over time in extremely low birth weight infants? Pediatrics 2004; 114:697.
- Ho JJ, Subramaniam P, Henderson-Smart DJ, Davis PG. Continuous distending pressure for respiratory distress syndrome in preterm infants. Cochrane Database Syst Rev 2002; :CD002271.
- Miller MJ, Carlo WA, Martin RJ. Continuous positive airway pressure selectively reduces obstructive apnea in preterm infants. J Pediatr 1985; 106:91.
- Stark AR, Goldman MD, Frantz ID 3rd. Lung volume changes, occlusion pressure and chest wall configuration in human infants. Pediatr Res 1979; 13:250.
- Schmölzer GM, Kumar M, Pichler G, et al. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis. BMJ 2013; 347:f5980.
- Davis PG, Henderson-Smart DJ. Nasal continuous positive airways pressure immediately after extubation for preventing morbidity in preterm infants. Cochrane Database Syst Rev 2003; :CD000143.
- Buzzella B, Claure N, D'Ugard C, Bancalari E. A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants. J Pediatr 2014; 164:46.
- Diblasi RM. Nasal continuous positive airway pressure (CPAP) for the respiratory care of the newborn infant. Respir Care 2009; 54:1209.
- Claure N, Bancalari E. New modes of mechanical ventilation in the preterm newborn: evidence of benefit. Arch Dis Child Fetal Neonatal Ed 2007; 92:F508.
- Bhandari V. Nasal intermittent positive pressure ventilation in the newborn: review of literature and evidence-based guidelines. J Perinatol 2010; 30:505.
- Stein H, Beck J, Dunn M. Non-invasive ventilation with neurally adjusted ventilatory assist in newborns. Semin Fetal Neonatal Med 2016; 21:154.
- Thompson AE. Pediatric airway management. In: Pediatric Critical Care, 3rd ed, Fuhman BP, Zimmerman J (Eds), Mosby Elsevier, Philadelphia 2006. p.485.
- Williams AJ. ABC of oxygen: assessing and interpreting arterial blood gases and acid-base balance. BMJ 1998; 317:1213.
- Harsten A, Berg B, Inerot S, Muth L. Importance of correct handling of samples for the results of blood gas analysis. Acta Anaesthesiol Scand 1988; 32:365.
- Hansen JE, Simmons DH. A systematic error in the determination of blood PCO2. Am Rev Respir Dis 1977; 115:1061.
- Neff TA. Routine oximetry. A fifth vital sign? Chest 1988; 94:227.
- Hay WW Jr, Brockway JM, Eyzaguirre M. Neonatal pulse oximetry: accuracy and reliability. Pediatrics 1989; 83:717.
- Durand M, Ramanathan R. Pulse oximetry for continuous oxygen monitoring in sick newborn infants. J Pediatr 1986; 109:1052.
- Levesque BM, Pollack P, Griffin BE, Nielsen HC. Pulse oximetry: what's normal in the newborn nursery? Pediatr Pulmonol 2000; 30:406.
- Brockmann PE, Poets A, Urschitz MS, et al. Reference values for pulse oximetry recordings in healthy term neonates during their first 5 days of life. Arch Dis Child Fetal Neonatal Ed 2011; 96:F335.
- Harigopal S, Satish HP, Taktak AF, et al. Oxygen saturation profile in healthy preterm infants. Arch Dis Child Fetal Neonatal Ed 2011; 96:F339.
- Greenspan JS, Goldsmith JP. Oxygen therapy in preterm infants: hitting the target. Pediatrics 2006; 118:1740.
- Poets CF, Southall DP. Noninvasive monitoring of oxygenation in infants and children: practical considerations and areas of concern. Pediatrics 1994; 93:737.
- Vagedes J, Poets CF, Dietz K. Averaging time, desaturation level, duration and extent. Arch Dis Child Fetal Neonatal Ed 2013; 98:F265.
- Jennis MS, Peabody JL. Pulse oximetry: an alternative method for the assessment of oxygenation in newborn infants. Pediatrics 1987; 79:524.
- OXYGEN DELIVERY MODALITIES
- Neonatal resuscitation
- - Nasal cannula
- Low flow
- High flow
- - Prongs and devices
- - Guidelines
- - Continuous positive airway pressure
- CPAP systems
- Our approach
- - Nasal intermittent positive pressure ventilation
- Noninvasive neurally adjusted ventilatory assist
- - Bilevel nasal CPAP
- - Intubation and mechanical ventilation
- - Other oxygen delivery systems
- Face mask
- MEASUREMENT OF OXYGENATION
- Arterial blood gas measurement
- - Specimen collection
- - Sources of error
- Pulse oximetry
- - Sources of error
- Transcutaneous oxygen monitoring
- SUMMARY AND RECOMMENDATIONS