When Not to Intubate Babies Receiving 100 % Oxygen

Abstract

Pulse oximetry screening of neonates is becoming routine practice across most hospitals in the UK. It has 75 % sensitivity and 99 % specificity for identifying babies with significant congenital heart disease. The suggested management of a baby who fails pulse oximetry screening is review by a doctor who should undertake a hyperoxia test. Those babies who fail the test are very likely to have congenital heart disease. Pulse oximetry screening also identifies babies who present with PPHN and hypoxia for non-cardiac reasons. It can be challenging to decide when to intubate and ventilate these babies who have failed pulse oximetry and are ‘requiring 100 % oxygen’. When in doubt, it is best practice to start a prostaglandin infusion and then support the ventilation as required. We illustrate this with two cases that failed the pulse oximetry screening and had increasing oxygen requirements of up to 100 % via 6 L optiflow. Intubation and ventilation were avoided by assessing the baby’s history and clinical signs together with blood gas findings. Echocardiography subsequently confirmed the cardiac diagnoses.