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Query: UMLS:C0242706 (hyperoxia)
 5,219 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Persistent pulmonary hypertension of the newborn (PPHN) characterised by right to left shunting with intense cyanosis is difficult to manage, and in the best of centres carries a 40-60 percent mortality. We report our one year's experience of managing six neonates with PPHN. There were 5 males and 1 female with mean birth weight of 2.59 +/- 0.487 kg and gestation period 39 +/- 2.0 wks and 1 minute Apgar score 2.8 +/- 2.1. Four to six babies were born by cesarean section and 3-6 babies had aspiration pneumonia. All babies presented within 12 hours of age (mean 5.08 +/- 5 hrs) with intense cyanosis and respiratory distress. Diagnosis were confirmed in all by (a) hyperoxia test, (b) simultaneous determination of preductal and postductal paO2 (c) contrast echocardiography and (d) hyperoxia-hyperventilation test. Babies were managed with hyperventilation using mean ventilatory rates of 100 +/- 45 per minute, an inspired oxygen concentration of 100%, peak inspiratory pressures 27 +/- 9 cm of H2O, and expiratory pressures 5 +/- 1.6 cms of H2O, and mean air way pressures of 10.4 +/- 2.7 cms H2O. Alkali therapy was used in 3 of the six babies whereas low dose dopamine was infused in all six babies. Inspite of aggressive ventilatory therapy, only 3 out of 6 babies could be salvaged.
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PMID:Persistent pulmonary arterial hypertension of the newborn. 134 Aug 63

Transcutaneous oxygen monitoring has been used successfully in the assessment of trend in tissue oxygenation in neonates and children. This study highlights the application of transcutaneous oxygen monitoring in three unusual clinical situations: dual channel oxygen monitoring in persistent foetal circulation, hyperoxia test in the differentiation of cardiac or pulmonary central cyanosis and the effect of endotracheal intubation on tissue oxygenation. Its usefulness and potential application in these situations are discussed.
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PMID:Transcutaneous estimation of oxygen tension in unusual clinical situations. 407 6

There are several unique aspects of O2 therapy in infants. Inhalation of O2 by preterm infants decreases the frequency of apnea and cyanosis, and increases the ventilatory response to CO2, but the reasons for this are unclear. Immature infants receiving O2 therapy are subject to retinopathy, but we do not know the magnitude or duration of hyperoxia necessary to damage the developing retina. Newborns with persistent pulmonary hypertension, without radiographic signs of pulmonary disease, frequently remain hypoxemic despite breathing 100% O2. In these infants, the unresponsiveness of teh postnatal pulmonary circulation to high concentrations of inspired O2 needs elucidation. Babies with respiratory failure who are treated with O2 and mechanical ventilation often acquire chronic pulmonary disease. The etiologic importance of O2 compared to postive airway pressure in the development of this condition remains controversial. Some laboratory studies suggest that newborn animals are resistant to pulmonary injury from O2; other studies indicate that youth offers no protection. The results of experiments carried out with newborn mice and lambs provide evidence that diet may be an important element in the susceptibility of newborn animals to pulmonary O2 toxicity.
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PMID:Special considerations in oxygen therapy of infants and children. 677 80

Drainage of the inferior vena cava into the left atrium during surgery for closure of an atrial septal defect is a rare complication. More common in low situated defects, it was more frequent when this type of surgery was performed without cardiopulmonary bypass. This diagnosis was made in a 45 year old woman with cyanosis operated 28 years previously. The right-to-left shunt was demonstrated by the hyperoxia test and confirmed by perfusion pulmonary scintigraphy and contrast echocardiography but only when the contrast was injected in the inferior vena cava territory, and by angiography. The surgeon confirmed the abnormality, closed the interatrial septum and reconnected the inferior vena cava to the right atrium.
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PMID:[Late discovery of inferior vena cava draining into the left atrium after surgical closure of atrial septal defect]. 933 62

This article describes the experimental infrastructure and subsequent successful clinical application of a comprehensive bypass and cardioplegic strategy that limits intraoperative injury and improves postoperative outcomes in pediatric patients. The infant heart is at high risk of damage from poor protection because of preoperative hypertrophy, cyanosis, and ischemia. The background factors of vulnerability to damage caused by cyanosis and ischemia are discussed, together with studies of the infrastructure of strategies to use normoxia versus hyperoxia as bypass starts, white blood cell filtration, warm induction and reperfusion with substrate enhancements, multidose blood cardioplegia, and an integrated approach to allow ischemia only when vision is needed in pediatric surgeries. Data on cardioplegic management, including reducing calcium, increasing magnesium, and reducing perfusion pressure are shown, as used during this technique. These principles were applied to a consecutive series of 567 patients at the Heart Institute for Children and University of Illinois hospital over a 2-year period. Included also were 72 patients with hypoplastic left heart over a 4-year period with this myocardial management strategy. Application of these concepts may improve the safety of protection in infant hearts.
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PMID:Pediatric myocardial protection: an overview. 1130 28

Congenital heart diseases may remain asymptomatic for days or weeks after birth. Early diagnosis of prenatally undiagnosed congenital heart diseases rests upon familial history of congenital heart disease and clinical signs such as cyanosis intrauterine growth retardation, tachypnea, excessive sweating, feeding difficulties, or abnormal cardiac auscultation. Hyperoxia test, blood gas determination, chest x-ray and electrocardiogram are the most useful complementary tests before the anatomical evaluation by the pediatric cardiologist. The initial medical management includes mechanical ventilation and oxygen supplementation, insertion of a good quality central or peripheral vascular line, correction of metabolic disorders, sedation, and prostaglandin administration in order to maintain the opening of the ductus arteriosus.
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PMID:[Early management of neonates with suspected congenital heart disease]. 1168 6

The case of a right-to-left shunt-induced hypoxemia with an abnormal return of the inferior vena cava (AIVCR) into the left atrium (LA) is reported in a 30-year-old male with cyanosis and polycythemia. The chest X ray and the lung CT scan was normal. Spirometry was normal but the transfert-CO coefficient (KCO) was lowered. Hypoxemia was observed at rest and worsening during exercise. The alveolo-arterial oxygen tension difference under hyperoxia was increased (56 kPa). Contrast echocardiography (CEch) suggested the presence of an AIVCR with a right-to-left shunt only observed by the inferior route. The inferior vena cava (IVC) angiography and the magnetic resonance imaging demonstrated an AIVCR characterized by a direct drainage of IVC in the left atrium. The good tolerance can be explained by the association of AIVCR with an inter-auricular septal defect resulting in a left-to-right shunt which partially corrected the right-to-left shunt. After surgical treatment, arterial blood gases normalized, KCO remained low and CEch became negative.
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PMID:[Hypoxemia secondary to inferior vena cava return into left atrium]. 1192 87

Early detection of hepatopulmonary syndrome (HPS) may be delayed because of invasiveness of the diagnostic procedures. In this pilot study, we prospectively investigated the usefulness of determining transcutaneous O(2) tension after 100% O(2) (TcPO(2)100) breathing using a transcutaneous hyperoxia test (THT) in 11 children with chronic cholestasis and without primary cardiopulmonary disease. These patients also underwent alveolar-arterial O(2) gradient testing (AaDO(2)) at an inspired oxygen fraction (FiO(2)) of 0.21, lung scintiscan, and contrast transthoracic echocardiography (TTE). Three of them had a liver transplantation because of the downhill course of their liver disease and respiratory status. THT transcutaneous O(2) tension at 21% FiO(2) (TcPO(2)21) was 75 +/- 13 mm Hg, and increased to 488 +/- 106 mmHg after 100% O(2) breathing (TcPO(2)100). Both mean values were not significantly different from those found in 8 age-matched controls (P = 0.9 and P = 0.5, respectively). However, one patient, in spite of her stable liver function, showed an abnormal TcPO(2)21 and TcPO(2)100 (45 mmHg and 210 mmHg, respectively). This same subject was also the only patient with abnormalities of AaDO(2) (54.2 mm Hg; normal value, < 20 mm Hg), lung scintiscan (brain/lung ratio of technetium-99 fixation (B/L SI) = 9, normal value < 1), and TTE, suggesting intrapulmonary vasodilatations and shunts. Given the clinical development of cyanosis and platypnea, all criteria for HPS were fulfilled, and timing of her liver transplantation was therefore accelerated. This resulted in HPS regression. In children with chronic cholestasis, repeated transcutaneous bedside measurements are a rapid and reliable noninvasive test for characterizing the severity of abnormal oxygenation, and may prove useful also in liver posttransplantation monitoring.
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PMID:Noninvasive investigation of hepatopulmonary syndrome in children and adolescents with chronic cholestasis. 1194 83

Newborn infants may be transferred to a special care nursery because of conditions such as prematurity (gestation less than 37 weeks), prolonged resuscitation, respiratory distress, cyanosis, and jaundice, and for evaluation of neonatal sepsis. Newborn infants' core temperature should be kept above 36.4 degrees C (97.5 degrees F). Nutritional requirements are usually 100 to 120 kcal per kg per day to achieve an average weight gain of 150 to 200 g (5 to 7 oz) per week. Standard infant formulas containing 20 kcal per mL and maternal breast milk may be inadequate for premature infants, who require special formulas or fortifiers that provide a higher calorie content (up to 24 kcal per mL). Intravenous fluids should be given when infants are not being fed enterally, such as those with tachypnea greater than 60 breaths per minute. Hypoglycemia can be asymptomatic in large-for-gestational-age infants and infants of mothers who have diabetes. A hyperoxia test can be used to differentiate between pulmonary and cardiac causes of hypoxemia. The potential for neonatal sepsis increases with the presence of risk factors such as prolonged rupture of membranes and maternal colonization with group B streptococcus. Jaundice, especially on the first day of life, should be evaluated and treated. If the infant does not progressively improve in the special care nursery, transfer to a tertiary care unit may be necessary.
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PMID:Common issues in the care of sick neonates. 1244 67

We present a case study of a newborn girl with a reduced erythrocytic nicotinamide adenine dinucleotide (NADH)-dependent methaemoglobin reductase level. Within the first days of life she developed cyanosis due to a methaemoglobin level of 21%. The hyperoxia test was characteristic, with normal increases in blood oxygen tension, whereas the oxygen saturation remained constant at 92%. Over the next months the methaemoglobin level decreased to 10%, and the girl did well without treatment.
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PMID:[Congenital methaemoglobinaemia: an infrequent cause of neonatal cyanosis]. 1876 34


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