An Infant in our Practice Has Persistent Oxygen Needs.
What should I do? When should you see this child?
What infants should cause concerned?
Three groups of infants should raise concerns: 1) the previously normal infant who now needs prolonged or recurrent oxygen; 2) the term infant with persistent oxygen requirements; and 3) the pre-term infant with oxygen requirements that seem out of proportion to their prematurity. Infants with associated failure to thrive should raise further concern.
What oxygen needs should cause concern?
Increased oxygen needs past 6-8 weeks, recurring oxygen needs or rapidly progressing oxygen needs may indicate the possibility of an underlying or complicating condition. Even though infants may need oxygen after pulmonary insults such as RSV or pneumonia, prolonged use past 8 weeks may also warrant further investigation.
What are the causes of persistent oxygen requirements?
The most common causes involve abnormal ventilation and perfusion matching in the lungs related to a more severe pulmonary insult than was appreciated, structural abnormalities of the airways or the lungs or unrecognized disease, such as Cystic Fibrosis, interstitial lung disease, immune deficiency or aspiration. Cardiac causes must also be considered. In infants younger than 6 months, periodic breathing may contribute to prolonged oxygen needs. Most of these conditions would benefit from subspecialty pulmonary consultation.
What should I do?
The diagnostic evaluation is frequently completed in phases guided by important clues from the history and physical. Initial evaluations in the primary care office should include a CBC, capillary or venous blood gas, electrolytes, chest radiograph and room air oxygen saturation. As the diagnostic possibilities are so divergent and specialized testing may be required, consultation with the pulmonary Breathing Institute to guide further work up would be advised. For example, Children's Hospital Colorado Breathing Institute has specific nationally recommended protocols for chest CT scans, lung function, sleep studies in infants as well as physicians with national reputations in conditions that cause prolonged oxygen needs. This level of expertise is not routinely available in other locations.