Paeds Cases · fetal-neonatal-and-perinatal
A rising-FiO2 preterm on CPAP — OSCE
OSCE on managing a 27-week preterm whose inspired oxygen climbs on nasal CPAP, testing the surfactant threshold, the LISA approach, oxygen targeting and the prevention of bronchopulmonary dysplasia.
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You are the neonatal registrar called to review a 27-week gestation infant two hours after birth. The infant was born to a mother who received a full course of antenatal corticosteroids. The birth weight is 920 grams, the temperature is 36.8 degrees, and the infant is on nasal CPAP at 6 cm of water. The inspired oxygen has risen over the last hour from 0.25 to 0.38, with grunting, marked subcostal retractions and nasal flaring. The pre-ductal saturation is 92 percent at the current FiO2. A chest radiograph shows low lung volumes with fine granular opacities and air bronchograms. [1]
References4ShowHide
- [1]Sweet DG European Consensus Guidelines on the Management of Respiratory Distress Syndrome: 2022 Update. Neonatology, 2023.PMID 36863329
- [2]Polin RA Surfactant replacement therapy for preterm and term neonates with respiratory distress. Pediatrics, 2014.PMID 24379227
- [5]Askie LM Association Between Oxygen Saturation Targeting and Death or Disability in Extremely Preterm Infants in the Neonatal Oxygenation Prospective Meta-analysis Collaboration. JAMA, 2018.PMID 29872859
- [8]Schmidt B Long-term effects of caffeine therapy for apnea of prematurity. N Engl J Med, 2007.PMID 17989382