Title: The Hyperoxia Test for the Cyanotic Infant (submitted by Nicholas Fern, MBBS)<br/>Author: Mimi Lu<br/><a href='http://umem.org/profiles/faculty/185/'>[Click to email author]</a><hr/><p>
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<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">The hyperoxia-hyperventilation test (aka 100% Oxygen Challenge test) is used to differentiate the cause of central cyanosis in the sick neonate. The majority of neonatal cyanosis is caused by either cardiac or respiratory pathology.</span></p>
<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">Classically the test is performed as follows:</span></p>
<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">1. An ABG is obtained with the neonate breathing room air</span></p>
<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">2. The patient is placed on 100% FiO2 for 10 minutes</span></p>
<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">3. A repeat ABG is performed looking for an increase in PaO2 to >150 mmHg</span></p>
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auto;text-indent:-.25in;mso-list:l0 level1 lfo1">
<span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri"> <span style="mso-list:Ignore">-<span new="" style="font:7.0pt " times=""> </span></span></span><span style="mso-ascii-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri">If the hypoxia is secondary to a respiratory cause, the PaO2 should increase to >150 mmHg.</span></p>
<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri"><span style="mso-list:Ignore">-<span new="" style="font:7.0pt " times=""> </span></span></span><span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">If the hypoxia is secondary to a congenital cardiac lesion (i.e. secondary to a right-to-left cardiac shunt) the PaO2 is not expected to rise significantly. </span></p>
<p class="MsoNormal">
<span style="mso-ascii-font-family:Calibri;mso-hansi-font-family:
Calibri;mso-bidi-font-family:Calibri">In practice, many physicians instead use pulse oximetry and monitor the SpO2 pre and post administration of 10 minutes of 100% FiO2. </span></p>
<p class="MsoListParagraphCxSpFirst" style="text-indent:-.25in;mso-list:l1 level1 lfo2">
<span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri"><span style="mso-list:Ignore">-<span new="" style="font:7.0pt " times=""> </span></span></span><span style="mso-ascii-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri">If after 10min of 100% FiO2, if SpO2 is not </span><span cambria="" style="font-family:">?</span><span style="mso-ascii-font-family:
Calibri;mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri"> 95% (some resources use 85%) then the central cyanosis is likely secondary to intracardiac shunt.</span></p>
<p class="MsoListParagraphCxSpLast" style="text-indent:-.25in;mso-list:l1 level1 lfo2">
<span style="mso-ascii-font-family:Calibri;mso-fareast-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri"><span style="mso-list:Ignore">-<span new="" style="font:7.0pt " times=""> </span></span></span><span style="mso-ascii-font-family:Calibri;
mso-hansi-font-family:Calibri;mso-bidi-font-family:Calibri">When this occurs, presume the sick neonate is symptomatic from a congenital cardiac lesion and initiate prostaglandin E-1 (PGE1) at 0.05-0.01 mcg/kg/min. Use caution as PGE1 may cause apnea. </span></p>