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Arch Dis Child Fetal Neonatal Ed. Mar 1999; 80(2): F81–F87.
PMCID: PMC1720913

Haemodynamic effects of altering arterial oxygen saturation in preterm infants with respiratory failure

Abstract

AIMS—To examine the haemodynamic effects of brief alteration in arterial oxygenation in preterm infants with respiratory failure.
METHODS—Eighteen preterm infants with respiratory failure, aged 9-76 hours, underwent detailed Doppler echocardiographic assessment at 86%, 96%, and 100% SaO2, achieved by altering the FIO2. Sixteen were receiving intermittent positive pressure ventilation, median FIO2 0.45 (0.20-0.65), median mean airway pressure 12 cm H2O (0-20). SaO2 was stable for 15 minutes at each stage. Four parameters of pulmonary arterial pressure were measured: peak velocity of tricuspid regurgitation and peak velocity of left to right ductal flow, TPV:RVET ratio and PEP:RVET ratio, measured at the pulmonary valve, along with flow velocity integrals at the aortic and pulmonary valves, and systemic arterial pressure. Ductal size was graded into closed, small, moderate, large with imaging, pulsed and continuous wave Doppler.
RESULTS—Between 86% and 96% SaO2, there were no consistent changes, but in three of the 12 with a patent ductus arteriosus (PDA) there was ductal constriction, with complete closure in one. Between 96% and 100% SaO2, peak ductal flow velocity rose significantly in four of eight with a PDA. Ductal constriction occurred in four infants; in three this was associated with a significant fall in aortic flow integral and a rise in aortic pressure (4-6 mm Hg). Overall, 11 infants went from 86% to 100% SaO2 and pulmonary arterial pressure fell significantly in seven.
CONCLUSION—A brief rise in SaO2 within the range maintained by most neonatal units can cause significant ductal constriction. The fall in pulmonary arterial pressure with 100% SaO2 seen in most infants was associated with a fall in pulmonary blood flow (or no change), rather than a rise, indicating that the dominant haemodynamic effect was ductal constriction rather than pulmonary vasodilation.

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Selected References

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  • ASHTON N, WARD B, SERPELL G. Effect of oxygen on developing retinal vessels with particular reference to the problem of retrolental fibroplasia. Br J Ophthalmol. 1954 Jul;38(7):397–432. [PMC free article] [PubMed]
  • PATZ A, EASTHAM A, HIGGINBOTHAM DH, KLEH T. Oxygen studies in retrolental fibroplasia. II. The production of the microscopic changes of retrolental fibroplasia in experimental animals. Am J Ophthalmol. 1953 Nov;36(11):1511–1522. [PubMed]
  • Ashton N, Garner A, Knight G. Intermittent oxygen in retrolental fibroplasia. Am J Ophthalmol. 1971 Jan;71(1 Pt 2):153–160. [PubMed]
  • Halliday H, Hirschfeld S, Riggs T, Liebman J, Fanaroff A, Bormuth C. Respiratory distress syndrome: echocardiographic assessment of cardiovascular function and pulmonary vascular resistance. Pediatrics. 1977 Oct;60(4):444–449. [PubMed]
  • Skinner JR, Boys RJ, Hunter S, Hey EN. Pulmonary and systemic arterial pressure in hyaline membrane disease. Arch Dis Child. 1992 Apr;67(4 Spec No):366–373. [PMC free article] [PubMed]
  • Evans NJ, Archer LN. Doppler assessment of pulmonary artery pressure and extrapulmonary shunting in the acute phase of hyaline membrane disease. Arch Dis Child. 1991 Jan;66(1 Spec No):6–11. [PMC free article] [PubMed]
  • COOK CD, DRINKER PA, JACOBSON HN, LEVISON H, STRANG LB. CONTROL OF PULMONARY BLOOD FLOW IN THE FOETAL AND NEWLY BORN LAMB. J Physiol. 1963 Nov;169:10–29. [PMC free article] [PubMed]
  • CASSIN S, DAWES GS, MOTT JC, ROSS BB, STRANG LB. THE VASCULAR RESISTANCE OF THE FOETAL AND NEWLY VENTILATED LUNG OF THE LAMB. J Physiol. 1964 May;171:61–79. [PMC free article] [PubMed]
  • MOSS AJ, EMMANOUILIDES GC, ADAMS FH, CHUANG K. RESPONSE OF DUCTUS ARTERIOSUS AND PULMONARY AND SYSTEMIC ARTERIAL PRESSURE TO CHANGES IN OXYGEN ENVIRONMENT IN NEWBORN INFANTS. Pediatrics. 1964 Jun;33:937–944. [PubMed]
  • Poets CF, Stebbens VA, Alexander JR, Arrowsmith WA, Salfield SA, Southall DP. Arterial oxygen saturation in preterm infants at discharge from the hospital and six weeks later. J Pediatr. 1992 Mar;120(3):447–454. [PubMed]
  • Southall DP, Bignall S, Stebbens VA, Alexander JR, Rivers RP, Lissauer T. Pulse oximeter and transcutaneous arterial oxygen measurements in neonatal and paediatric intensive care. Arch Dis Child. 1987 Sep;62(9):882–888. [PMC free article] [PubMed]
  • Bucher HU, Fanconi S, Baeckert P, Duc G. Hyperoxemia in newborn infants: detection by pulse oximetry. Pediatrics. 1989 Aug;84(2):226–230. [PubMed]
  • Hirschfeld S, Meyer R, Schwartz DC, Kofhagen J, Kaplan S. The echocardiographic assessment of pulmonary artery pressure and pulmonary vascular resistance. Circulation. 1975 Oct;52(4):642–650. [PubMed]
  • Kosturakis D, Goldberg SJ, Allen HD, Loeber C. Doppler echocardiographic prediction of pulmonary arterial hypertension in congenital heart disease. Am J Cardiol. 1984 Apr 1;53(8):1110–1115. [PubMed]
  • Stevenson JG. Comparison of several noninvasive methods for estimation of pulmonary artery pressure. J Am Soc Echocardiogr. 1989 May-Jun;2(3):157–171. [PubMed]
  • Musewe NN, Poppe D, Smallhorn JF, Hellman J, Whyte H, Smith B, Freedom RM. Doppler echocardiographic measurement of pulmonary artery pressure from ductal Doppler velocities in the newborn. J Am Coll Cardiol. 1990 Feb;15(2):446–456. [PubMed]
  • Walther FJ, Benders MJ, Leighton JO. Early changes in the neonatal circulatory transition. J Pediatr. 1993 Oct;123(4):625–632. [PubMed]
  • Skinner JR, Boys RJ, Hunter S, Hey EN. Non-invasive assessment of pulmonary arterial pressure in healthy neonates. Arch Dis Child. 1991 Apr;66(4 Spec No):386–390. [PMC free article] [PubMed]
  • Skinner JR, Stuart AG, O'Sullivan J, Heads A, Boys RJ, Hunter S. Right heart pressure determination by Doppler in infants with tricuspid regurgitation. Arch Dis Child. 1993 Aug;69(2):216–220. [PMC free article] [PubMed]
  • Skinner JR, Boys RJ, Heads A, Hey EN, Hunter S. Estimation of pulmonary arterial pressure in the newborn: study of the repeatability of four Doppler echocardiographic techniques. Pediatr Cardiol. 1996 Nov-Dec;17(6):360–369. [PubMed]
  • Alverson DC, Eldridge MW, Johnson JD, Aldrich M, Angelus P, Berman W., Jr Noninvasive measurement of cardiac output in healthy preterm and term newborn infants. Am J Perinatol. 1984 Jan;1(2):148–151. [PubMed]
  • Skinner JR, Hunter S, Hey EN. Haemodynamic features at presentation in persistent pulmonary hypertension of the newborn and outcome. Arch Dis Child Fetal Neonatal Ed. 1996 Jan;74(1):F26–F32. [PMC free article] [PubMed]
  • Evans N, Kluckow M. Early determinants of right and left ventricular output in ventilated preterm infants. Arch Dis Child Fetal Neonatal Ed. 1996 Mar;74(2):F88–F94. [PMC free article] [PubMed]
  • Houston AB, Lim MK, Doig WB, Gnanapragasam J, Coleman EN, Jamieson MP, Pollock JC. Doppler flow characteristics in the assessment of pulmonary artery pressure in ductus arteriosus. Br Heart J. 1989 Oct;62(4):284–290. [PMC free article] [PubMed]
  • Dabestani A, Mahan G, Gardin JM, Takenaka K, Burn C, Allfie A, Henry WL. Evaluation of pulmonary artery pressure and resistance by pulsed Doppler echocardiography. Am J Cardiol. 1987 Mar 1;59(6):662–668. [PubMed]
  • Friedman DM, Bierman FZ, Barst R. Gated pulsed Doppler evaluation of idiopathic pulmonary artery hypertension in children. Am J Cardiol. 1986 Aug 1;58(3):369–370. [PubMed]
  • Benatar A, Clarke J, Silverman M. Pulmonary hypertension in infants with chronic lung disease: non-invasive evaluation and short term effect of oxygen treatment. Arch Dis Child Fetal Neonatal Ed. 1995 Jan;72(1):F14–F19. [PMC free article] [PubMed]
  • Mellander M, Larsson LE, Ekström-Jodal B, Sabel KG. Prediction of symptomatic patent ductus arteriosus in preterm infants using Doppler and M-mode echocardiography. Acta Paediatr Scand. 1987 Jul;76(4):553–559. [PubMed]
  • Abman SH, Wolfe RR, Accurso FJ, Koops BL, Bowman CM, Wiggins JW., Jr Pulmonary vascular response to oxygen in infants with severe bronchopulmonary dysplasia. Pediatrics. 1985 Jan;75(1):80–84. [PubMed]
  • Halliday HL, Dumpit FM, Brady JP. Effects of inspired oxygen on echocardiographic assessment of pulmonary vascular resistance and myocardial contractility in bronchopulmonary dysplasia. Pediatrics. 1980 Mar;65(3):536–540. [PubMed]
  • Roberton NR, Dahlenburg GW. Ductus arteriosus shunts in the respiratory distress syndrome. Pediatr Res. 1969 Mar;3(2):149–159. [PubMed]
  • Schulze A, Whyte RK, Way RC, Sinclair JC. Effect of the arterial oxygenation level on cardiac output, oxygen extraction, and oxygen consumption in low birth weight infants receiving mechanical ventilation. J Pediatr. 1995 May;126(5 Pt 1):777–784. [PubMed]
  • Skinner J. The effects of surfactant on haemodynamics in hyaline membrane disease. Arch Dis Child Fetal Neonatal Ed. 1997 Mar;76(2):F67–F69. [PMC free article] [PubMed]
  • Hay WW, Jr, Thilo E, Curlander JB. Pulse oximetry in neonatal medicine. Clin Perinatol. 1991 Sep;18(3):441–472. [PubMed]
  • Flynn JT, Bancalari E, Snyder ES, Goldberg RN, Feuer W, Cassady J, Schiffman J, Feldman HI, Bachynski B, Buckley E, et al. A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity. N Engl J Med. 1992 Apr 16;326(16):1050–1054. [PubMed]

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