Cyanosis primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Prenatal diagnosis

  • Most congenital heart defects can be identified by fetal echocardiography.
  • Guidelines of the International Society for Ultrasound in Obstetrics and Gynecology recommends Ultra Sound assessment of the outflow tracts. [41].
  • Less than half of patients with critical congenital heart defects were routinely identified. [10,42-44].

Antenatal corticosteroid therapy

  • Antenatal corticosteroid therapy should be administered to all pregnant women at 23 to 34 weeks who are at increased risk of preterm delivery within the next seven days to prevent or decrease the severity of neonatal RDS.
  • Coericosteroids enhances maturational changes in fetal lung architecture and biochemistry with increased synthesis and release of surfactant, resulting in improved neonatal lung function.

Assisted ventilation techniques

  • Respiratory support that prevents and reduces atelectasis should be administered to all preterm infants who are at risk for RDS.
  • The less invasive modalities have replaced intubation and mechanical ventilation as the initial intervention that provides positive pressure to reduce the risk of atelectasis. Nasal continuous positive airway pressure (nCPAP) is the preferred modality to provide positive end-expiratory pressure.
  • Intubation and mechanical ventilation with PEEP may be needed in case of failed previous maneuvers.
  • Prophylactic caffeine therapy is recommended in extremely low birth weight infants (BW <1000 g) as these patients universally will have apnea of prematurity and are at greatest risk for developing BPD. 17.
  • Other indications for mechanical ventilation include:
  • Respiratory acidosis, documented by an arterial pH <7.2 and partial pressure of arterial carbon dioxide (PaCO2) >60 to 65 mmHg
  • Hypoxemia documented by an arterial partial pressure of oxygen (PaO2) <50 mmHg despite oxygen supplementation, or when the fraction of inspired concentration (FiO2) exceeds 0.40 on nCPAP
  • Severe apnea

References



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