Joseph J. Vettukattil* Pages 1 - 4 ( 4 )
Despite our growing experience in medical care of extremely preterm infants, there are serious gaps in the understanding of the adaptive physiology of the newborn. This is often misinterpreted and considered similar to that of adult physiology. The human psyche has been seriously influenced, both from an evolutionary and survival point of view, by the cause and effect of hypoxemia which is considered as a warning sign of impending death. Within this context it is unimaginable for even the highly trained professionals to consider saturation as low as 65% as acceptable. However, all available data suggests that newborns can thrive in a hypoxemic environment as they are conditioned to withstand extreme low saturations in the fetal environment. An approach utilizing the benefits of the hypoxic conditioning would prompt the practice of optimal targeted oxygen saturation range. Our current understanding of cyanotic congenital heart disease and the physiology of single ventricle circulation, where oxygen saturation in mid 70s is acceptable, is supported by clinical and animal studies. Our article recommends similar target oxygen levels in the critically ill newborn. We challenge the current practice and associated risks compared with permissive hypoxia to avoid the associated morbidity and mortality of oxygen radical injury.
cyanotic congenital heart disease, hypoxic preconditioning, hypoxemic hypoxic preconditioning, ischemic preconditioning, primary hypoxic preconditioning
Congenital Heart Center, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, MI