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PEDIATRICS Vol. 102 No. 5 November 1998, p. e53

ELECTRONIC ARTICLE:
Hyperbaric Oxygen Therapy in the Pediatric Patient: The Experience of the Israel Naval Medical Institute

Received Jan 28, 1998; accepted Jun 23, 1998.

Dan Waisman*, parallel , Avi ShupakDagger , parallel , Giora Weisz§, parallel , and Yehuda Melamedparallel ,

From the Departments of * Neonatology, Dagger  Otolaryngology, and § Cardiology, Carmel Medical Center and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; parallel  Israel Naval Medical Institute, Haifa, Israel; and  Hyperbaric Medical Center-Elisha-Rambam Hospitals, Haifa, Israel.

The pediatric patient is to be found in hyperbaric facilities throughout the world, receiving hyperbaric oxygen (HBO) therapy for both life-threatening and chronic diseases.

Objective.  To review the experience accumulated at the Israel Naval Medical Institute in the treatment of pediatric patients.

Design.  A retrospective analysis and review of all records of patients younger than age 18 years.

Results.  Between 1980 and 1997, 139 pediatric patients age 2 months to 18 years (mean, 7.7 years) received HBO treatment at the Israel Naval Medical Institute. Of the children, 111 (79%) suffered from acute carbon monoxide (CO) poisoning; 13 (9.2%) were treated after crush injury, traumatic ischemia, or compartment syndrome; 4 (2.8%) had clostridial myonecrosis; 1 (0.7%) had necrotizing fasciitis; 5 (3.6%) had refractory osteomyelitis; 2 (1.4%) had suffered massive air embolism; 2 (1.4%) had purpura fulminans; and 1 (0.7%) suffered from decompression sickness. Outcome, judged by neurologic sequelae, mortality, and extent of soft tissue loss and limb amputation, was favorable in 129 patients (93%). Two patients (1.4%) died, 1 as a result of CO poisoning and the other, gas gangrene; 2 of the patients in the CO group (1.4%) remained with neurologic sequelae, and 6 patients in the acute traumatic ischemia group (4.3%) underwent limb amputation.

Conclusions.  We had a favorable experience with 129 of a total 139 pediatric patients treated at our facility for the indications listed. A basic knowledge of HBO therapy is needed to refer the pediatric patient for treatment when indicated. The needs of the pediatric patient, especially the critically ill, require specific skills and equipment inside the hyperbaric chamber. Close collaboration between the pediatrician and the hyperbaric medicine physician is essential to ensure adequate care for infants and children.

 Key words:  hyperbaric oxygenation, pediatrics, carbon monoxide poisoning, crush injury, gas gangrene, necrotizing fasciitis, refractory osteomyelitis, purpura fulminans, decompression sickness, arterial gas embolism.




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