HYPERBARIC TREATMENT OF NEONATES

Background: Hyperbaric treatment of neonates started in the 60’s but almost completely stopped in the 70’s. We believe neonates can be effectively managed in a monoplace chamber. Objective: To determine the value of HBO in the management of intestinal ischemia, necrotizing enterocolitis and anoxic encephalopathy of neonates, and to determine the incidence of ocular, pulmonary and CNS oxygen toxicity. Design: Prospective pilot study. Methods: Neonates with intestinal ischemia, necrotizing enterocolitis or anoxic encephalopathy older that 34 weeks of gestation and above 1200g of weight, were evaluated and treated in a Sechrist monoplace chamber (3200) with a neonatologist as an inside attendant. Treatment consisted of HBO 2.0 atm abs /45min/BID (one air break of 5 minutes included). Preventive myringotomies were done before the first treatment. All of the patients treated within 6 hours of delivery resolved with only one treatment. Those treated after 24 h required more that one treatment, two of which developed pulmonary oxygen toxicity, but responded well to inhaled steroids and surfactant (Survanta). Sepsis and DIC resolved after the first treatment, as did cerebral edema. No ophthalmic side effects were detected after HBO and at 3 and 6 month follow-up. All patients were monitored with tcPo2 that allowed us to evaluate each patient’s ventilatory status. Conclusions: Preliminary results suggest that HBO is a safe and effective treatment in neonates. There is a need for a prospective, randomized, controlled and double-blinded study to determine precisely the place of HBO in the management of acute ischemic/hypoxic conditions neonates.