A premature baby was admitted in the nursery and received oxygen therapy by oxyhood. At the 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 2023

Explanation

• Premature infants have incompletely vascularized retinas, making them vulnerable to the effects of supplemental oxygen.
• High concentrations of oxygen (hyperoxemia) can disrupt normal retinal vessel growth, leading to a condition called Retinopathy of Prematurity (ROP).
• ROP involves abnormal proliferation of blood vessels that can cause retinal detachment and permanent blindness.
• Due to this severe risk, a mandatory eye examination to screen for ROP is essential before discharging any premature infant who has received oxygen therapy.

Why Other Options Were Wrong

• Option A: While skin integrity is a general concern in neonates, the skin is not the specific organ system at highest risk for severe, irreversible damage from oxygen toxicity delivered via an oxyhood.
• Option B: Hearing loss in premature infants is a concern, but it is primarily associated with factors like genetic predisposition, infections (e.g., CMV), hyperbilirubinemia, and treatment with ototoxic drugs (e.g., aminoglycosides), not directly with oxygen therapy.
• Option D: An oxyhood is a device that fits over the infant's head and does not insert into or make direct contact with the nose. Therefore, it does not cause the nasal trauma, septal injury, or irritation that can occur with nasal cannulas or CPAP prongs.

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 are at the forefront of ROP prevention. This involves meticulous monitoring of oxygen saturation, adhering strictly to prescribed target ranges, and promptly responding to alarms to avoid fluctuations and hyperoxemia.
• The nurse acts as a patient advocate by ensuring that the mandatory ROP screening is scheduled, performed, and the results are documented and communicated to the healthcare team and parents before discharge.
• What if? If the infant were a full-term baby instead of premature, the risk of ROP from oxygen therapy would be extremely low because retinal vascularization is complete. In that case, while oxygen toxicity is still a concern for other organs (like the lungs), a routine discharge eye exam for ROP would not be indicated.

How to Approach the Question

• First, identify the key elements of the clinical scenario: the patient is a 'premature baby' and the intervention is 'oxygen therapy'.
• Recall the major physiological differences of a premature infant, particularly the immaturity of their organ systems.
• Consider the known complications associated with oxygen therapy in this specific, vulnerable population.
• Connect the intervention (oxygen) to its most critical and well-known complication in premature infants, which is Retinopathy of Prematurity (ROP).
• Recognize that ROP is a disease of the eye that can lead to blindness.
• Conclude that the eye is the most important organ to examine carefully before discharge to screen for this specific, high-risk complication.

Concept Tested & Keywords

• Concept Tested: Complications of oxygen therapy in premature infants
• Stem keywords: premature baby, oxygen therapy, oxyhood, discharge examination
• Lead-in keywords: carefully examined
• Clinical cues: Patient is a premature baby, which indicates immature organ systems.
• Clinical cues: Intervention is oxygen therapy, a known risk factor for specific complications in this population.

Question ID

QovWhsu_FJHDxaeo7dSv8q

Copy ID

Reference Book

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

E6 Obstetrics Williams p. 28-48