30 weeker with PDA

[Pajefferson16]

Hello! New NICU nurse here with a question about oxygen. There's a little 30 weeker in our unit with a medium sized PDA. She's currently on oxygen, & she frequently desats into the low 70's and takes a while to come back up. How long should I wait for her to come up on her sats before I do something? I don't want to mess around with her oxygen if it's not needed.

Thanks in advance!

[prmenrs, RN]

I believe your baby is opening and closing her Duct. More O2 won't help, in all likelihood, and it's toxic. The duct needs to be closed medically or surgically. Is she getting medication to help it close? She should be on indomethicin. If that doesn't work, she should probably go to surgery.

Get parameters ordered: if sats get below x, increase FiO2 by y. Try not to "chase" the sats. They may not want it increased unless her HR goes down.

[prmenrs, RN]

One thing you could try--if Resp will let you--is to turn the rate up (assuming she's on some sort of assisted ventilation) a couple. Don't let the baby's sats go > than ~ 92%, or whatever upper parameter the docs have specified.

Babies like this can't make up their mind whether to be blind or stupid. (and, yes, I am kidding!)

[adventure_rn, MSN, NP]

When I first started as a NICU nurse, one of the hardest things for me to learn was when to intervene with a brady and/or desat and when to ride it out. My initial instinct (like most new grads) was to jump in an intervene, and I ended up chasing the sats. Every baby is different, and every unit is different. Some units (and some particular nurses) have a higher tolerance for kids desating, while others jump in within seconds to right the ship.

Unfortunately, there's no clear answer. Even Merenstein and Gardner state that there's very little research on what our O2 parameters for preemies should be; too high and you damage the eyes/lungs, too low and you damage everything else. You have to just go by your unit's standards/orders/policies, and eventually you'll get a feel for it.

My best advice is to ask the off-going nurse what has worked best to address this specific baby's events; s/he will know if this particular baby is likely to bring herself out of it, or if once she hits 70% she's going to need Os to prevent a downward desat/brady spiral. I try to remember to ask this question on all of my kids who are frequently eventing. It's also ok to ask other nurses on your unit for their advice, and just use trial and error (within reason) to figure out the best combo of intervention/waiting for that particular kid on that particular day.

[SteveNNP, MSN, NP]

How old is this baby? The nice thing about fetal hemoglobin is that it holds onto a LOT more oxygen at lower saturations than our blood. So you can rest assured that even if sats are in the 70s, she's still probably not getting too hypoxic...as long as she's not staying there for too long.

In my unit, if this baby were less than 14 days old, we would consider her symptomatic, and use either indomethacin or ibuprofen lysine to attempt to close the duct. If greater than 14 days, we would consider a PDA ligation.