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pO2
Ensuring adequate oxygen supply to the tissues and organs is possibly the most important goal in the care of a sick neonate.Hypoxia and ischemia are as dangerous in neonates and infants as they are in adults. However, hyperoxia seems to be particularly endangering to neonates. It may lead to an increased risk of retinopathy, toxicity in the lungs or a possible reduction in cerebral blood flow.
Because the oxygen status of a neonate changes rapidly, continuous monitoring of pO2 is an essential part of neonatal care.
pCO2
Hypocapnia may lead to brain and lung damage in neonates and infants, while hypercapnia can result in acidosis. Sudden upward changes in pCO2 also indicate changes in the condition of the child or complications in the way the patient is responding to treatment.Case: Cerebral blood flow
A girl born after 25 gestational weeks at a district hospital. She was intubated immediately and given surfactant. Umbilical lines were inserted. The baby was ventilated with reasonable pressures and at a rate of 40/min. Good oxygenation and circulation. The retrieval team arrived less than two hours after the birth and transported the girl for 85 minutes to the central university hospital.
At departure, pCO2(aB) is 37 mmHg (4.9 kPa), and ventilator rate was reduced. pCO2 was not monitored during transport. At arrival at the receiving hospital, pCO2(aB) was 21 mmHg (2.8 kPa) with blood pressure, heart rate and oxygenation being satisfactory.
The low pCO2 value placed the baby at risk of cerebral damage and could have been avoided by monitoring pCO2 during the transfer.
Case: Pneumothorax
A girl, born at gestational age of 25 weeks, initially treated with two doses of surfactant. On day 3 she was still on ventilator with low airway pressures and oxygen demands. Within 30 minutes she developed an increase in tcpCO2 from 38 mmHg (5.1 kPa) to 50 mmHg (6.7 kPa) without any change in oxygenation.
The baby did not show any change in her condition following tracheal suction. Chest X-ray revealed right-sided pneumothorax, which was drained immediately, and her condition improved.
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