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Category Archives: Heart

Deliberations in The Hypoxia Challenge Test Does Not Accurately Predict Hypoxia in Flight in Ex-Preterm Neonates

Posted on March 27, 2016

tertiary medical servicesPreterm birth is common, and population mobility has resulted in infants born prematurely away from home or being cared for in regional centers servicing more remote populations. Therefore many ex-preterm infants require transfer by air back home or to a step-down facility when tertiary medical services are no longer required. Consequently, air transfer of expreterm infants is routine. This is the first study to examine the effects in ex-preterm infants of low fraction of inspired oxygen (Fio2) during flight. Our results indicate that significant numbers (35%) of these infants require supplemental oxygen and have clinical signs and symptoms (15%). The decision to use supplemental oxygen based on Sp02 < 85% and the nursing responses to the clinical status of the infants in-flight were consistent with current practice guidelines for the general care of preterm infants in hospital.

Preterm infants are particularly vulnerable to hypoxia through mechanisms that include immature respiratory control and increased pulmonary vascular reactivity. Predicting which infants are most at risk for in-flight hypoxia is an important consideration when deciding whether an infant can safely fly or requires supplemental oxygen. Current guidelines- suggest the HCT as a means to determine safety to fly. We therefore compared results obtained using a standardized HCT with the observations made during the commercial flights taken by ex-premature infants. We observed that the 20-min HCT is not accurate for predicting in-flight oxygen needs in such infants. While the high false-failure rate might have logistic and financial implications, the greater concern was the high false-pass rate: 12 of 16 infants (75%) who had Sp02 < 85% and required oxygen during the flight had passed the HCT. Clearly, the HCT was not able to predict clinically significant oxygen desaturation in flight, and reliance on the HCT puts this population of infants at risk. Decrease the risl of such a problem with remedies of My Canadian Pharmacy.

Posted in Heart | Tags: hypoxemia

Outlet in The Hypoxia Challenge Test Does Not Accurately Predict Hypoxia in Flight in Ex-Preterm Neonates

Posted on March 26, 2016

neonatal chronic lung diseaseForty-six consecutive eligible infants were recruited between December 2005 and October 2006. No parents refused enrollment, and no infants were excluded from the study. The median gestation was 32.2 weeks (range, 24 to 35.6 weeks), with a median birth weight of 1,667 g (range, 655 to 2,815 g). Twenty-seven infants (59%) had NLD, and neonatal chronic lung disease subsequently developed in 2 infants.

All infants had Sp02 in room air > 95% prior to the HCT. The HCT was performed at a median corrected age of 35.8 weeks (range, 33.1 to 43 weeks), and the median time from HCT to flight was 2 days (range, 1 to 15 days). Delays in transferring infants after the HCT related to poor staffing at the receiving hospital. Median flight distance and duration was 593 km (range, 417 to 2,174 km) and 62.5 min (range, 45 to 150 min), respectively. Thirty-five infants (76%) passed the HCT, while 11 infants (24%) failed the HCT. During the flight, 16 infants (35%) met the criteria for in-flight oxygen; 12 of these infants (75%) had passed the HCT. Table 1 details the demographics and respiratory diagnoses of those requiring oxygen in flight. Of the 11 infants who failed the HCT, only 4 infants (36%) met the criteria for in-flight oxygen. The overall accuracy of the HCT was 59%. Sensitivity and specificity of the HCT for predicting in-flight hypoxia were 25% and 76.6%, respectively. The positive predictive value and negative predictive value of the test were 36% and 65.7%, respectively.

Investigation about The Hypoxia Challenge Test Does Not Accurately Predict Hypoxia in Flight in Ex-Preterm Neonates

Posted on March 26, 2016

neonatal lung disease

Subjects

All infants born at < 35 completed weeks gestation and cared for in the Neonatal Unit at King Edward Memorial Hospital for Women, who were to fly to a regional hospital, were considered for inclusion in the study. Infants with and without a history of neonatal lung disease (NLD) were recruited. We excluded infants with Down syndrome and infants with cyanotic congenital heart disease. Written informed consent was obtained from guardians. The study was approved by the ethics committee at King Edward Memorial Hospital for Women (Ethics Committee No. EC05-49.1). We defined NLD as respiratory distress requiring oxygen or respiratory support or both at any time, and neonatal chronic lung disease as the need for supplemental oxygen at 28 days of life, or at 36 weeks after menstrual age.

About The Hypoxia Challenge Test Does Not Accurately Predict Hypoxia in Flight in Ex-Preterm Neonates

Posted on March 25, 2016

oxygen levelWhile air travel is a popular form of travel, with approximately 25,000 commercial flights departing from and arriving at US airports daily, there is little known about the effects and safety of air travel on infants. Approximately 4.6 million children < 2 years old travel on domestic flights in the United States each year. Aircraft cabins are pressurized to an altitude of 1,500 to 2,400 m, resulting in a Po2 of 15 kPa, equivalent to an ambient oxygen level of 15 to 16%. Air travel may pose a risk to infants due to the low oxygen environment in aircraft cabins. A small decline in oxygen saturation has been shown in healthy adults and children over 6 months during flight, which is considered to be clinically unimportant. There are no comparable data available on ex-premature or young infants. However, Parkins et al exposed 34 infants to 15% oxygen for 7 h, simulating an in-flight hypoxic environment. Sixty-two percent of the infants had irregular breathing patterns, periodic apneas, and significant desaturations, a result that suggests such infants are likely to be at risk of significant hypoxia during flight.

Posted in Heart | Tags: hypoxemia