Oxygen therapy in preterm infants with pulmonary hypertension

Praveen Chandrasekharan, Satyan Lakshminrusimha

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article number101070
JournalSeminars in Fetal and Neonatal Medicine
DOIs
StateAccepted/In press - Jan 1 2019

Keywords

  • Bronchopulmonary dysplasia associated pulmonary hypertension
  • Oxygen saturation target
  • Preterm pulmonary hypertension
  • Supplemental oxygen

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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