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ISSN (Print): 1570-1638
ISSN (Online): 1875-6220

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Hypoxic Gas Therapy in Neonatology: Considerations in Practice

Author(s): Jorge Luis Alvarado Socarras*, Delia Edith Theurel Martin and Edgar Fabian Manrique Hernández

Volume 19, Issue 5, 2022

Published on: 04 August, 2022

Article ID: e200522205067 Pages: 5

DOI: 10.2174/1570163819666220520112220

Abstract

Background: Adequate oxygenation is essential for sick newborns. Each disease determines the target of oxygenation. Nevertheless, hyperoxia and hypoxia are related to adverse outcomes. Most studies related to this aspect have been conducted in preterm infants or term babies with pulmonary pathology.

Introduction: Congenital heart diseases may also require careful oxygenation control and management of oxygen supply.

Methods: Presurgical stabilization of complex heart diseases (CHD) may be difficult, especially after the physiological decrease of pulmonary resistance, which generates pulmonary edema (due to overcirculation) and systemic hypoperfusion. Several strategies have been described to avoid this phenomenon, such as prostaglandin, vasodilators, inotropes, positive airway pressure, and even hypoxic mixture (inspired fraction of oxygen (FiO2) below 21%).

Discussion: The latter therapy is mainly used in single ventricular physiology heart diseases, such as the hypoplasic left heart syndrome (HLHS) or systemic ductus-dependent flow CHD (interruption of the aortic arch and coarctation of the aorta). Alveolar oxygen affects pulmonary vascular resistance modifying lung flow. This modification could help the stabilization during the presurgical period of complex CDH. Many centers use hypoxic therapy to avoid hypotension, metabolic acidosis, coronarycerebral ischemia, and liver, renal and intestinal injury. Despite the theoretical benefits, there are doubts about how tissue oxygen supply would change during hypoxic gas ventilation. It is worrisome that FiO2 < 21% causes a decrease in brain oxygenation, adding neurological injury as a complication to the already established disease of CHD and other not modifiable factors. Brain monitoring through near-infrared spectroscopy (NIRS) during hypoxic gas therapy is mandatory. Recent studies have shown that hypoxic gas ventilation therapy in patients with HLHS in the preoperative period decreases the ratio between systemic and pulmonary circulation (Qp/Qs) but does not improve regional oxygenation delivery. The use of hypoxic gas ventilation therapy continues to be controversial. It could be an option in some complex CHD, mainly HLHS.

Keywords: Congenital heart disease, neonate, hypoplastic left heart syndrome, hypoxic gas, nitrogen, fraction of inspired oxygen.

Graphical Abstract

[1]
Kim E, Nguyen M. Oxygen therapy for neonatal resuscitation in the delivery room. Neoreviews 2019; 20(9): e500-12.
[http://dx.doi.org/10.1542/neo.20-9-e500] [PMID: 31477598]
[2]
Myers TR. Therapeutic gases for neonatal and pediatric respiratory care. Respir Care 2003; 48(4): 399-422.
[PMID: 12667267]
[3]
Schmidt B, Whyte RK. Oxygen saturation target ranges and alarm settings in the NICU: What have we learnt from the neonatal oxygenation prospective meta-analysis (NeOProM)? Semin Fetal Neonatal Med 2020; 25(2): 101080.
[http://dx.doi.org/10.1016/j.siny.2020.101080] [PMID: 31983671]
[4]
Vento M, Saugstad OD. Targeting oxygen in term and preterm infants starting at birth. Clin Perinatol 2019; 46(3): 459-73.
[http://dx.doi.org/10.1016/j.clp.2019.05.013] [PMID: 31345541]
[5]
Askie LM, Darlow BA, Finer N, et al. Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration. JAMA -. JAMA 2018; 319(21): 2190-201.
[http://dx.doi.org/10.1001/jama.2018.5725] [PMID: 29872859]
[6]
Toiyama K, Hamaoka K, Oka T, et al. Changes in cerebral oxygen saturation and blood flow during hypoxic gas ventilation therapy in HLHS and CoA/IAA complex with markedly increased pulmonary blood flow. Circ J 2010; 74(10): 2125-31.
[http://dx.doi.org/10.1253/circj.CJ-09-0833] [PMID: 20736506]
[7]
Cardiol RE, Pm E, Guidelines ESE, Force T, Cardiomyopathy H, Society E, et al. Jorge Nuche 2020; 73(2): 2020-2.
[8]
Tabbutt S, Ramamoorthy C, Montenegro LM, et al. Impact of inspired gas mixtures on preoperative infants with hypoplastic left heart syndrome during controlled ventilation. Circulation 2001; 104(12)(Suppl. 1): I159-64.
[http://dx.doi.org/10.1161/hc37t1.094818] [PMID: 11568049]
[9]
Nioka S, Chance B, Smith DS, et al. Cerebral energy metabolism and oxygen state during hypoxia in neonate and adult dogs. Pediatr Res 1990; 28(1): 54-62.
[http://dx.doi.org/10.1203/00006450-199007000-00013] [PMID: 2377397]
[10]
Vettukattil JJ. Target oxygen levels and critical care of the newborn. Curr Pediatr Rev 2020; 16(1): 2-5.
[http://dx.doi.org/10.2174/1573396315666191016094828] [PMID: 31622221]
[11]
Verges S, Chacaroun S, Godin-Ribuot D, Baillieul S. Hypoxic conditioning as a new therapeutic modality. Front Pediatr 2015; 3: 58.
[http://dx.doi.org/10.3389/fped.2015.00058] [PMID: 26157787]
[12]
Tan T, Mizobe N, Sugiyama H, et al. Supplemental nitrogen inhalation therapy in very low-birth-weight infants with patent ductus arteriosus. Pediatr Cardiol 2005; 26(6): 801-4.
[http://dx.doi.org/10.1007/s00246-005-0947-y] [PMID: 16132276]
[13]
Keidan I, Mishaly D, Berkenstadt H, Perel A. Combining low inspired oxygen and carbon dioxide during mechanical ventilation for the Norwood procedure. Paediatr Anaesth 2003; 13(1): 58-62.
[http://dx.doi.org/10.1046/j.1460-9592.2003.00975.x] [PMID: 12535041]
[14]
Khalil M, Jux C, Rueblinger L, Behrje J, Esmaeili A, Schranz D. Acute therapy of newborns with critical congenital heart disease. Transl Pediatr 2019; 8(2): 114-26.
[http://dx.doi.org/10.21037/tp.2019.04.06] [PMID: 31161078]
[15]
Shime N, Hashimoto S, Hiramatsu N, Oka T, Kageyama K, Tanaka Y. Hypoxic gas therapy using nitrogen in the preoperative management of neonates with hypoplastic left heart syndrome. Pediatr Crit Care Med 2000; 1(1): 38-41.
[http://dx.doi.org/10.1097/00130478-200007000-00007] [PMID: 12813284]
[16]
Green A, Pye S, Yetman AT. The physiologic basis for and nursing considerations in the use of subatmospheric concentrations of oxygen in HLHS. Adv Neonatal Care 2002; 2(4): 177-86.
[http://dx.doi.org/10.1053/adnc.2002.33542] [PMID: 12881932]
[17]
Thomas L, Flores S, Wong J, Loomba R. Acute effects of hypoxic gas admixtures on pulmonary blood flow and regional oxygenation in children awaiting norwood palliation. Cureus 2019; 11(9): e5693.
[http://dx.doi.org/10.7759/cureus.5693] [PMID: 31720161]
[18]
Howell HB, Zaccario M, Kazmi SH, Desai P, Sklamberg FE, Mally P. Neurodevelopmental outcomes of children with congenital heart disease: A review. Curr Probl Pediatr Adolesc Health Care 2019; 49(10): 100685.
[http://dx.doi.org/10.1016/j.cppeds.2019.100685] [PMID: 31708366]
[19]
El-Dib M, Soul JS. Monitoring and management of brain hemodynamics and oxygenation. Handb Clin Neurol 2019; 162: 295-314.
[http://dx.doi.org/10.1016/B978-0-444-64029-1.00014-X] [PMID: 31324316]
[20]
Hoffman GM, Brosig CL, Mussatto KA, Tweddell JS, Ghanayem NS. Perioperative cerebral oxygen saturation in neonates with hypoplastic left heart syndrome and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 2013; 146(5): 1153-64.
[http://dx.doi.org/10.1016/j.jtcvs.2012.12.060] [PMID: 23317941]
[21]
Tran NN, Votava-Smith JK, Wood JC, et al. Cerebral oxygen saturation and cerebrovascular instability in newborn infants with congenital heart disease compared to healthy controls. PLoS One 2021; 16(5): e0251255.
[http://dx.doi.org/10.1371/journal.pone.0251255] [PMID: 33970937]

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