Oxygen therapy in preterm infants with pulmonary hypertension |
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| Institution: | 1. maximo.vento@uv.es;2. christian-f.poets@med.uni-tuebingen.de;1. Division of Neonatal–Perinatal Medicine, Department of Pediatrics and Communicable Diseases, C.S. Mott Children''s Hospital, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA;2. Department of Paediatrics and Neonatal Medicine, The James Cook University Hospital, Durham University, Middlesbrough, UK;1. Division of Neonatology, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA;2. RTI International, Research Triangle Park, NC;3. Department of Pediatrics, University of California Davis, Sacramento, CA;4. Case Western Reserve University, Cleveland, OH |
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| Abstract: | Premature neonates <34 weeks gestation can present with early-onset, late-onset and bronchopulmonary dysplasia (BPD) associated pulmonary hypertension (PHT), with clinical, echocardiographic, and histological features similar to term infants with PHT. Changes in pulmonary vascular resistance (PVR) in response to oxygen are diminished in preterm infants compared to term. Studies from preterm lambs and human infants with BPD have shown that PaO2 > 30–55 mm Hg promotes pulmonary vasodilation. Targeting saturations of 80–85% by 5 min, 85–95% by 10 min during resuscitation and 90–95% during the postnatal course are appropriate targets for routine management of preterm infants. Among preterm infants with PHT, avoiding hypoxia/hyperoxia by titrating supplemental oxygen to maintain saturations in low to mid 90s with alarm limits at 90 and 97% seems to be a reasonable approach pending further studies. Further high-quality evidence generated from randomized trials is required to guide oxygen therapy in preterm PHT. |
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| Keywords: | Preterm pulmonary hypertension Supplemental oxygen Oxygen saturation target Bronchopulmonary dysplasia associated pulmonary hypertension |
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