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 (picture 1). 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.
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- 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