BNF for Children 2011-2012

BNFC 2011–2012 3.6 Oxygen 163ment’ in preterm neonates of 29 weeks or less postmenstrualage.Pulmonary surfactants may also be of benefit in neonateswith meconium aspiration syndrome or intrapartumstreptococcal infection.Pulmonary immaturity with surfactant deficit is thecommonest reason for respiratory failure in the neonate,especially in those of less than 30 weeks post-menstrualage. Betamethasone (section 6.3.2) given to the mother(at least 12 hours but preferably 48 hours) before deliverysubstantially enhances pulmonary maturity in theneonate.Cautions Continuous monitoring is required to avoidhyperoxaemia caused by rapid improvement in arterialoxygen concentration.Side-effects Pulmonary haemorrhage and bradycardiahave been rarely associated with pulmonarysurfactants. Obstruction of the endotracheal tube bymucous secretions, and intracranial haemorrhage havealso been reported.BERACTANTCautions see notes above and consult product literatureSide-effects see notes aboveLicensed use licensed for use in respiratory distresssyndrome in newborn premature infants, birthweightover 700 g, and as prophylaxis in neonatesless than 32 weeks post-menstrual ageIndication and doseTreatment of respiratory distress syndrome inpreterm neonate; prophylaxis of respiratorydistress syndrome in preterm neonate. By endotracheal tubeNeonate phospholipid 100 mg/kg equivalent to avolume of 4 mL/kg, preferably within 8 hours ofbirth (preferably within 15 minutes of birth forprophylaxis); dose may be repeated within 48hours at intervals of at least 6 hours for up to 4dosesSurvanta c (Abbott) ASuspension, beractant (bovine lung extract) providingphospholipid 25 mg/mL, with lipids and proteins,net price 8-mL vial = £306.43PORACTANT ALFACautions see notes above and consult product literatureSide-effects see notes above; also rarely hypotensionLicensed use licensed for use in respiratory distresssyndrome in newborn premature infants, birthweightover 700 g, and as prophylaxis in neonates24–32 weeks post-menstrual ageIndication and doseTreatment of respiratory distress syndrome orhyaline membrane disease in preterm neonate;prophylaxis of respiratory distress syndrome inpreterm neonate. By endotracheal tubeNeonate treatment, 100–200 mg/kg; further dosesof 100 mg/kg may be repeated at intervals of 12hours; max. total dose 300–400 mg/kg; prophylaxis,100–200 mg/kg soon after birth (preferablywithin 15 minutes); further doses of 100 mg/kgmay be repeated 6–12 hours later and after afurther 12 hours if still intubated; max. total dose300–400 mg/kgCurosurf c (Chiesi) ASuspension, poractant alfa (porcine lung phospholipidfraction) 80 mg/mL, net price 1.5-mL vial =£281.64; 3-mL vial = £547.403.6 OxygenOxygen should be regarded as a drug. It is prescribed forhypoxaemic patients to increase alveolar oxygen tensionand decrease the work of breathing. The concentrationof oxygen required depends on the conditionbeing treated; administration of an inappropriate concentrationof oxygen may have serious or even fatalconsequences. High concentrations of oxygen cancause pulmonary epithelial damage (bronchopulmonarydysplasia), convulsions, and retinal damage, especiallyin preterm neonates.Oxygen is probably the most common drug used inmedical emergencies. It should be prescribed initially toachieve a normal or near-normal oxygen saturation. Inmost acutely ill children with an expected or knownnormal or low arterial carbon dioxide (P a CO 2 ), oxygensaturation should be maintained above 92%; someclinicians may aim for a target of 94–98%. In someclinical situations, such as carbon monoxide poisoning,(see also Emergency Treatment of Poisoning, p. 33), it ismore appropriate to aim for the highest possible oxygensaturation until the child is stable. Hypercapnic respiratoryfailure is rare in children; in those children at risk,a lower oxygen saturation target of 88–92% is indicated,see below.High concentration oxygen therapy is safe in uncomplicatedcases of conditions such as pneumonia, pulmonaryembolism, pulmonary fibrosis, shock, severe trauma,sepsis, or anaphylaxis. In such conditions, lowarterial oxygen (P a O 2 ) is usually associated with lowor normal arterial carbon dioxide (P aCO 2) and there islittle risk of hypoventilation and carbon dioxide retention.In severe acute asthma, the arterial carbon dioxide(P a CO 2 ) is usually subnormal, but as asthma deterioratesit may rise steeply. These patients usually require ahigh concentration of oxygen and if the arterial carbondioxide (P a CO 2 ) remains high despite treatment, intermittentpositive pressure ventilation needs to be consideredurgently.Oxygen should not be given to neonates except underexpert supervision. Particular care is required in pretermneonates because of the risk of hyperoxia (seeabove).Low concentration oxygen therapy (controlled oxygentherapy) is reserved for children at risk of hypercapnicrespiratory failure, which is more likely in children with:. advanced cystic fibrosis;. advanced non-cystic fibrosis bronchiectasis;3 Respiratory system