Oxygen therapy in infants
Babies with heart or lung problems may need to breathe increased amounts of oxygen to get normal levels of oxygen in their blood. Oxygen therapy provides babies with extra oxygen.
Hypoxia - oxygen therapy in infants; Chronic lung disease - oxygen therapy in infants; BPD - oxygen therapy in infants; Bronchopulmonary dysplasia - oxygen therapy in infants
Oxygen is a gas that the cells in your body need to work properly. The air we breathe normally contains 21% oxygen. We can receive up to 100% oxygen.
HOW IS OXYGEN DELIVERED?
There are several ways to deliver oxygen to a baby. Which method is used depends on how much oxygen is needed and whether the baby needs a breathing machine. The baby must be able to breathe without assistance to use the first three types of oxygen therapy described below.
An oxygen hood or “head box” is used for babies who can breathe on their own but still need extra oxygen. A hood is a plastic dome or box with warm, moist oxygen inside. The hood is placed over the baby's head.
A thin, soft, plastic tube called a nasal cannula may be used instead of a hood. This tube has soft prongs that gently fit into the baby's nose. Oxygen flows through the tube.
Another method is a nasal CPAP system. CPAP stands for continuous positive airway pressure. It is used for babies who need more help than they can get from an oxygen hood or nasal cannula, but do not need a machine to breathe for them. A CPAP machine delivers oxygen through tubes with soft nasal prongs. The air is under higher pressure, which helps the airways and lungs stay open (inflate).
Finally, a breathing machine, or ventilator, may be needed to deliver increased oxygen and breathe for the baby. A ventilator can give CPAP alone with nasal prongs, but can also deliver breaths to the baby if the baby is too weak, tired, or sick to breathe. In this case, the oxygen flows through a tube placed down the baby's windpipe.
WHAT ARE THE RISKS OF OXYGEN?
Too much or too little oxygen can be harmful. If the cells in the body get too little oxygen, energy production decreases. With too little energy, cells may not work well and may die. Your baby may not grow properly. Many of the developing organs, including the brain and heart, may be injured.
Too much oxygen can also cause injury. Breathing too much oxygen can damage the lung. For babies who are born very prematurely, too much oxygen in the blood may also lead to problems in the brain and eye. Babies with certain heart conditions may also need lower levels of oxygen in the blood.
Your baby's health care providers will closely monitor and try to balance how much oxygen your baby needs. If you have questions about the risks and benefits of oxygen for your baby, discuss these with your baby's provider.
WHAT ARE THE RISKS OF OXYGEN DELIVERY SYSTEMS?
Infants receiving oxygen by hood may get cold if the temperature of the oxygen is not warm enough.
Some nasal cannulas use cool, dry oxygen. At higher flow rates, this can irritate the inner nose, causing cracked skin, bleeding, or mucus plugs in the nose. This can increase the risk for infection.
Similar problems can occur with nasal CPAP devices. Also, some CPAP devices use wide nasal prongs that can change the shape of the nose.
Mechanical ventilators have a number of risks as well. Your baby's providers will closely monitor and try to balance the risks and benefits of your baby's breathing support. If you have questions, discuss these with your baby's provider.
Bancalari E, Claure N, Jain D. Neonatal respiratory therapy. In: Gleason CA, Juul SE, eds. Avery's Diseases of the Newborn. 10th ed. Philadelphia, PA: Elsevier; 2018:chap 45.
Sarnaik AP, Heidemann SM, Clark JA. Respiratory pathophysiology and regulation. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 373.