Oxygen Therapy in Neonates

Introduction to Oxygen Delivery Devices

The American Thoracic Society recommends the use of nasal cannulas as the most widely used and preferred oxygen delivery device for neonates due to their convenience, safety, and tolerability, especially in the ambulatory setting 1
The selection of appropriate oxygen delivery devices for neonates should be based on the infant's clinical condition, oxygen requirements, and care setting 1

The American Academy of Pediatrics recommends the use of standard low-flow nasal cannula as the most widely used device for oxygen delivery in neonates, with advantages including convenience, safety, and tolerability, and allowing mobility 1
The delivered FiO₂ varies based on flow rate, infant size, respiratory rate, and respiratory effort, with typical flow rates of 0.25-2 L/min for neonates 2
Most centers recommend humidification of oxygen to prevent mucosal drying, with enhanced humidification strongly recommended 1

The American Heart Association recommends starting with lower oxygen concentration (21-30%) rather than higher (60-100%) and titrating oxygen using pulse oximetry to maintain target saturations 4
The American Academy of Pediatrics recommends avoiding FiO₂ >0.3 unless necessary to maintain target saturations and starting with 21% oxygen (room air) 4
The American Heart Association recommends targeting oxygen saturation ≥94% once circulation is restored and weaning FiO₂ for saturations of 100% to avoid hyperoxia while maintaining saturation ≥94% 3

For infants at risk of retinopathy of prematurity, more careful oxygen targeting is required, according to the American Academy of Pediatrics 1
Inadequate humidification can lead to mucosal drying and thickening of pulmonary secretions, with a solution of always humidifying oxygen when possible, as recommended by the American Thoracic Society 1
Commercial aircraft maintain cabin altitudes between 6,000-8,000 ft, reducing inspired PO₂, and increased oxygen requirements during flight due to lower barometric pressure, with key considerations including securing oxygen source, ensuring sufficient supply, and ability to monitor infant during travel, as recommended by the American Thoracic Society 1