Sunday, April 30, 2023

When does a baby need oxygen at home?

hypoxemia in children:

Chronic respiratory diseases can cause oxygen levels in the blood to be too low. When this occurs, it is called hypoxemia. Children with hypoxemia may need oxygen therapy at home after discharge from the hospital. This helps maintain normal blood oxygen levels so they can stay healthy.

What is hypoxemia​:

Like a fever, hypoxemia is a symptom of an underlying disease and not a disease itself. It can be caused by a variety of conditions and diseases, not just respiratory problems.

Some of the chronic respiratory diseases that can cause hypoxemia include:
  • bronchopulmonary dysplasia.
  • Sleep disordered breathing (sleep apnea).
  • Sickle-cell anaemia.
  • Pulmonary hypertension with or without congenital heart disease.
  • Cystic fibrosis.
  • interstitial lung disease.
  • Children with respiratory problems.
  • Children who depend (or depended) on a respirator to breathe.

If left untreated, hypoxemia can lead to problems such as:
  • poor nutrition.
  • poor growth.
  • poor sleep.
  • poor brain development.
  • Dangerous drop in heart rate (bradycardia).
  • Brief periods of not breathing (apnea).

Use of oxygen at home:

Babies who are medically stable and whose parents have received training can go home with oxygen to prevent hypoxemia. Being at home benefits both the emotional health of your child and that of your family. Caring for your baby at home also reduces health care costs.

For use at home, most babies receive oxygen through a nasal cannula, a small tube that fits into the baby's nostrils and clips around the head. In a small number of babies, oxygen is given through a tube in the neck called a tracheostomy, a continuous positive airway pressure machine, or a ventilator.

The doctor will indicate how much oxygen your baby needs. This is often written as a specific flow rate (eg ¼ liter of oxygen per minute) when using a nasal cannula. For a respirator or a continuous positive pressure machine, the doctor will indicate the necessary settings for the machine.

Home oxygen delivery systems:

There are three main types of oxygen delivery systems used at home, and they include:

- Compressed gas:

This is the most common type. Before your baby is discharged from the hospital, she will receive small pre-filled oxygen tanks at home. The number of tanks you receive will depend on how much oxygen your baby needs. You may also receive a large oxygen tank that is not portable. A representative from the durable medical equipment company will show you how to read the gauges to know when the tanks need to be refilled.

- Oxygen concentrator:

This device separates oxygen from the air and delivers it to your baby. They usually deliver it to your house and it runs on electricity. Someone from the medical equipment company will show you how to use it. A backup portable oxygen tank is also needed for when your baby is not near an electrical outlet or in case of a power outage.

- Liquid oxygen:

This is oxygen that has been cooled to a liquid state and stored in tanks. The liquid turns into a gas when your baby breathes it in. One of the reasons this system is not used as often is because liquid oxygen is expensive and insurance companies do not cover the cost. A tank of liquid oxygen takes up much less space than a large tank of compressed oxygen, but one major disadvantage of liquid oxygen is that if it's not being used, it evaporates.

Other equipment:

Depending on why your baby needs oxygen therapy, she may need to use an apnea monitor or pulse oximeter.

An apnea monitor is a device that uses wires with leads on the chest, or better around the chest, to monitor the baby's breathing rate and heart rate. The machine alerts you when the baby's breathing rate is slow or the heart rate drops, which could be a sign of respiratory distress. A pulse oximeter is a machine that uses a small cuff attached to a baby's wrist or ankle to measure oxygen levels in the blood.

You will be given instructions on how to use these machines before the baby is discharged. Also, your doctor will explain which readings require you to call a medical professional. Keep in mind that the alarm does not always indicate difficulties, so it is important that you observe the baby's breathing, color and activity.

Safety measures when using oxygen at home:

Whenever a baby comes home with instructions to use oxygen, certain safety measures must be followed:

  • Your baby's room should be well ventilated. You can keep the door open to ensure that the air in the room circulates well and does not get stuffy.
  • There is no smoking in the home of a baby receiving oxygen. You can hang a sign on the door to let people know that she is not allowed to smoke inside the house. Ask your medical equipment supplier or pediatrician's office for a poster.
  • Oxygen is a flammable gas; therefore, when her baby is receiving oxygen, she should keep it at least six feet (1.8 m) away from open flames, heaters, fireplaces, radiators, or gas appliances with pilot lights. Also, be sure to store all oxygen tanks at least six feet (1.8 m) away from any source of heat or fire.
  • Do not use rubbing alcohol, petroleum jelly, or aerosol cans near a baby receiving oxygen. Also avoid using hand sanitizer in the vicinity.
  • Make sure the smoke detectors in your home are working and regularly review your home fire escape plan with your family.

What else to expect:

Learn before you leave the hospital:

In the days before your baby is discharged from the hospital, you should become familiar with the equipment she will use at home and how she will need to care for your baby. The best way to learn all of this is to spend as much time as possible caring for your baby, at her crib, while she's in the neonatal intensive care unit (NICU). This will allow her to learn from the health care team and practice while she has the experts on hand to ask questions. Some NICUs have a room where parents can stay with the baby the night before they go home to help with the transition.

Nursing Home Visits:

Babies who go home with prescribed oxygen will likely receive nursing home visits that the doctor will coordinate through insurance. The nurse will check on your baby and make sure she is using all the equipment correctly. In addition, she will gladly answer any questions you may have about baby care. Most babies gradually wean themselves off oxygen as recommended by the child's doctor and a lung specialist called a pulmonologist.

Alert to essential services:

Make sure your health care team gives you letters to submit to the phone company, power company, and local emergency medical services (EMS) to alert them that you have a child with special needs in your home. Keep the phone numbers of your doctor and EMS or ambulance service in a handy and easily accessible place at home in case of a life-threatening emergency.

to remember:

While it might all seem overwhelming at first, you'll be turning pro before you know it. If you have any questions, contact your child's doctor or oxygen equipment supplier.