Dr. Samira Mohammad
Consultant pediatrician- lattakia-
Syria
OXYGEN THERABY IN PAEDIATRICS
SURVIVAL rate has improved for: prematures, low birth
weight, critically ill children with Respiratory and non- Respiratory
illnesses by oxygen therapy also morbidity and survival of chronic
lung disease. On the other hand retinopathy of prematurity, CLD,
brain asphyxia still encountered in best sophisticated NICU in
developed world as result of oxygen toxicity and being seen increasingly
in third world after widespread of NICU.
Hypoxaemia should be recognized early by oxygen saturation
measurement via pulse oxymetry a transceutanous non invasive
method, a value of less than 92% reflect hypoxaemia, remeasurement
of spao2 after half an hour of oxygen therapy and after any new
changes ,also continous monitoring in ICU possible ,frequent
sapO2 measurement in CLD possible. Spao2 should be kept above
92% reflecting pao2 (50-70) mmhg in neonate and pao2 (65-90)
for older children .Blood gases assessed 4-6 hourly in ICU and
in a child presenting with RDS tiering to asses ventilation or
the need for mechanical ventilation according to pco2 which reflect
aleveolar ventilation and PH ventilation indicated when : pco2
above 65% and ph below 7,20.
Oxygen given to children preferably by nasal canula
or nasopharyngeal tube which requires low flow oxygen 0,5-1 L/minute
and oxygen concentration 30%, also generate PEEP up to 4,5 cm
sufficient for treating apnoea; those devices are economic, lessening
oxygen toxicity, simple and good for developed and underdeveloped
countries.
In Syria oxygen therapy well established in ICU and
emergency of hospitals of Capital and big cities but the mortality
and oxygen toxicity still high reflecting unrefined practice
and monitoring, while in primary cares, rural hospitals and oxygen
supply not consistent and pulse oxymetry not present in all and
the knowledge for clinical assessment of sick children, oxygen
therapy, interpretation of pulseoxymertry
All insufficient and lacking and referral delay for
better secondary care..
New strategy needed for continous oxygen supply and
pulse oxymetry and impoved training for dealing with sick children
for first contact practioners and in hospitals.and for one and
good standard of care
Dr Samira Mohamad, Consultant paediatrician, MD-MRCP(UK)-FRCPCH
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