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. 2017 Feb;34(3):276-282.
doi: 10.1055/s-0036-1586754. Epub 2016 Aug 4.

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

Deepthi Alapati  1 , Romal Jassar  1 , Thomas H Shaffer  1
Affiliations

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

Deepthi Alapati et al. Am J Perinatol. 2017 Feb.

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.

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Figures

Fig. 1
Fig. 1
Initial oxygen titration parameters. (a) Percentage distribution of goal oxygenation parameters used for oxygen titration in initial persistent pulmonary hypertension of the newborn management for all responders. (b) Comparison of use of oxygenation parameters between neonatologists with or without greater than ten years of neonatal intensive care unit experience, with or without extracorporeal membrane oxygenation experience, and with or without use of specific O2 titration guidelines. Note: *p < 0.05.
Fig. 2
Fig. 2
Target preductal peripheral capillary oxygen saturation (SpO2) ranges for persistent pulmonary hypertension of the newborn (PPHN) management. (a) Percentage distribution of target ranges of SpO2 used for PPHN management for all responders. (b) Comparison of target ranges of SpO2 used by neonatologists with or without greater than ten years of neonatal intensive care unit experience, with or without extracorporeal membrane oxygenation experience and with or without use of specific O2 titration guidelines. Note: *p < 0.05.
Fig. 3
Fig. 3
Target partial pressure arterial oxygen (PaO2) ranges for persistent pulmonary hypertension of the newborn (PPHN) management. (a) Percentage distribution of target ranges of PaO2 used for PPHN management for all responders. (b) Comparison of target ranges of PaO2 used by neonatologists with or without greater than ten years of neonatal intensive care unit experience, with or without extracorporeal membrane oxygenation experience, and with or without use of specific O2 titration guidelines. Note: *p < 0.05.
Fig. 4
Fig. 4
Subsequent oxygen weaning practices. (a) Percentage distribution of oxygen weaning practices for all responders. (b) Comparison of FiO2 weaning practices amongst neonatologists with or without greater than ten years of neonatal intensive care unit experience, with or without extracorporeal membrane oxygenation experience, and with or without use of specific O2 titration guidelines. Note: *p < 0.05.
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