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Discussion

Decrease in O2 use on newborns

We recently did our annual competency training and as part of it we had one of our CNNP's from the NICU come talk to us about the use of O2 on newborns. They are asking us (I work in L&D) not to use O2 at delivery on most babies. There is some new research that the concentration of O2 is causing damage to the lungs. So now we are asked to continue to stimulate babies that have good respiratory effort but are just not pinking up, babies that we have routinely put O2 on previously, if the baby does not pink up with a few minutes we do a pulse ox and base the need for O2 off of the pulse ox, using the O2 at the lowest possible setting and for the shortest amount of time. Of course we will use O2 and CPAP on babies that need it.

Is anyone else getting this same information?

Thanks,

Molly

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  • Expert

There is research about this, but don't have references. Since it's not (@present) part of the NRP protocal, you're probably better off sticking to that--legally. But there is some thinking that, if the kid's paO2 in utero is 30, it might not be good to then have a paO2 of 300 immediately in the DR--that's where the concern for toxicity is, esp for premies. Both eyes and lungs are vulnerable.

There is a push to get blenders in all DRs and oxymeters so you know what the baby is getting, and to try to keep it from going so high.

Again, from a legal standpoint, follow the NRP, but be on the lookout for changes. If your DRs don't have blenders, lobby management to get them. And oxymeters.

We're even considering a study where we use 21% for resuscitation and go up in small increments if needed. We currently use blenders in resuscitations, but we start off at 100% and then wean down, which seems backwards considering our reasons for even doing it at all. We do still use blow by O2 at 100% for babies breathing. It's research and thinking like this that your CNNP's are basing their requests on. Actually, I think most of our concern about O2 and such is related to our preemies. Did you know that we are absolutely NOT to crank up the O2 even if it's a bad desat to the 40's or 50's, we're only supposed to go up 2-5% at a time. Cranking up and down is worse than actually being at 100% with preemies. We tend to not care much about O2 use in the big termers that never even end up down with us. And I agree with prmenrs, follow NRP unless your hospital has a black and white policy on it.

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