A premature baby was admitted in nursery and received oxygen therapy by oxyhood. At time of discharge which of the following should be carefully examined?

1. A

   Skin

2. B

   Ear

3. C

   Eye

4. D

   Nose

Appeared in: RML Lucknow - 2021

Explanation

• Premature infants receiving supplemental oxygen are at a significant risk for developing Retinopathy of Prematurity (ROP), a potentially blinding eye disorder.
• ROP is caused by hyperoxia (excessive oxygen), which disrupts the normal development of retinal blood vessels in the immature eye.
• This abnormal vessel growth can lead to scarring, retinal detachment, and permanent vision loss, making a thorough eye examination by an ophthalmologist essential before discharge.

Why Other Options Were Wrong

• Option A: While oxygen can have a drying effect on the skin, this is a minor, non-critical issue that can be managed with routine skin care and is not the primary life-altering complication to screen for.
• Option B: Routine hearing screening is important for all premature infants due to risks from prematurity itself, but hearing loss is not a specific complication directly caused by oxygen administration via an oxyhood.
• Option D: The nasal passages may become dry or irritated from the oxygen flow, but this is a minor, manageable side effect and does not carry the risk of permanent disability associated with ROP.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Complications of oxygen therapy in premature infants to guide bedside assessment, documentation, and the next nursing action.
• Nurses play a critical role in preventing ROP by meticulously managing oxygen delivery, using blenders to provide precise concentrations, and maintaining SpO2 saturation within the target range (e.g., 91-95%) as prescribed.
• A key nursing responsibility at discharge is to educate parents on the absolute importance of attending all scheduled follow-up ophthalmology appointments for ROP screening, as early detection and treatment are vital to prevent blindness.
• What if? If the infant were full-term, the risk of ROP from oxygen therapy would be significantly lower because their retinal vasculature is more mature. The focus of concern would shift to other potential complications related to their primary illness rather than ROP.

How to Approach the Question

• First, identify the key clinical details in the question: a 'premature baby' and 'oxygen therapy'.
• Next, recall the major complications associated with this specific intervention in this vulnerable patient population.
• Connect the intervention (oxygen therapy) to its most critical potential side effect. High-concentration oxygen in premature infants is strongly and specifically linked to eye damage.
• Evaluate each option based on this connection. The 'Eye' is the correct answer because of the high risk of Retinopathy of Prematurity (ROP), a sight-threatening condition.
• Rule out the other options by recognizing they are either minor side effects (skin/nose dryness) or general risks of prematurity not specifically caused by oxygen therapy (hearing issues).

Concept Tested & Keywords

• Concept Tested: Complications of oxygen therapy in premature infants.
• Stem keywords: premature baby, nursery, oxygen therapy, oxyhood, discharge
• Lead-in keywords: carefully examined
• Clinical cues: The combination of a premature baby and oxygen therapy is a strong indicator for the risk of Retinopathy of Prematurity (ROP).

Question ID

Qj0QWXIGMQxCf5X0OtUq_t

Copy ID

Reference Book

E6 Obstetrics Williams p. 28-48

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 153-155