Safety first!: a critical call for standardized infant flight protocols

SESSION TITLE: Pediatrics Global Case Report Posters 1 SESSION TYPE: Global Case Reports PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm INTRODUCTION: Infants who travel by air are often exposed to unique physiologic challenges that can increase their risk of morbidity and mortality. This is especially true for premature infants. We present the case of a premature infant who developed severe respiratory distress during a commercial flight and the implications of in-flight infant physiology as a call for protective guidelines. INTRODUCTION: Infants who travel by air are often exposed to unique physiologic challenges that can increase their risk of morbidity and mortality. This is especially true for premature infants. We present the case of a premature infant who developed severe respiratory distress during a commercial flight and the implications of in-flight infant physiology as a call for protective guidelines. CASE PRESENTATION: The patient, born at 28 weeks gestation, embarked on a 7-hour commercial flight home at 36 weeks, shortly after hospital discharge and on room air. One hour into the flight, he developed severe respiratory distress. He was supported with oxygen through an adult interface during an emergency landing, medically evacuated to the nearest NICU, and stabilized. The patient was repatriated 2 weeks later on a commercial flight, with oxygen and without incident. CASE PRESENTATION: The patient, born at 28 weeks gestation, embarked on a 7-hour commercial flight home at 36 weeks, shortly after hospital discharge and on room air. One hour into the flight, he developed severe respiratory distress. He was supported with oxygen through an adult interface during an emergency landing, medically evacuated to the nearest NICU, and stabilized. The patient was repatriated 2 weeks later on a commercial flight, with oxygen and without incident. DISCUSSION: Commercial air travel is usually at altitudes of 9150-13,000 m but pressurized to an equivalent of 1530-2440 m to avoid hypoxia. However, the atmospheric partial pressure of oxygen at 2440 meters is equivalent to 15-16% FiO2, which can lead to hypoxemia. Infants are particularly vulnerable due to their increased airway resistance, their potential for developing pulmonary hypertension and apneic episodes, and a shift in the oxygen dissociation curve due to fetal hemoglobin. Premature infants are especially at risk until a corrected gestational age of about 36 weeks. This case highlights the need for fitness-to-fly guidelines for premature infants and infants recently on supplemental oxygen. DISCUSSION: Commercial air travel is usually at altitudes of 9150-13,000 m but pressurized to an equivalent of 1530-2440 m to avoid hypoxia. However, the atmospheric partial pressure of oxygen at 2440 meters is equivalent to 15-16% FiO2, which can lead to hypoxemia. Infants are particularly vulnerable due to their increased airway resistance, their potential for developing pulmonary hypertension and apneic episodes, and a shift in the oxygen dissociation curve due to fetal hemoglobin. Premature infants are especially at risk until a corrected gestational age of about 36 weeks. This case highlights the need for fitness-to-fly guidelines for premature infants and infants recently on supplemental oxygen. CONCLUSIONS: Premature infants and infants with respiratory conditions are at increased risk for adverse events during air travel due to their unique physiology. Clinicians caring for these patients should be aware of the potential risks and take appropriate measures, such as consulting with a pediatric pulmonologist and providing supplemental oxygen during their flight, to ensure safe air travel. Research on the impact of in-flight physiology on premature infants and the development of fitness-to-fly guidelines for this vulnerable population are paramount. CONCLUSIONS: Premature infants and infants with respiratory conditions are at increased risk for adverse events during air travel due to their unique physiology. Clinicians caring for these patients should be aware of the potential risks and take appropriate measures, such as consulting with a pediatric pulmonologist and providing supplemental oxygen during their flight, to ensure safe air travel. Research on the impact of in-flight physiology on premature infants and the development of fitness-to-fly guidelines for this vulnerable population are paramount. REFERENCE #1: Lee AP, Yamamoto LG, Relles NL. Commercial airline travel decreases oxygen saturation in children. Pediatr Emerg Care. 2002;18(2):78-80. REFERENCE #1: Lee AP, Yamamoto LG, Relles NL. Commercial airline travel decreases oxygen saturation in children. Pediatr Emerg Care. 2002;18(2):78-80. REFERENCE #2: Udomittipong K, Stick SM, Verheggen M, Oostryck J, Sly PD, Hall GL. Pre-flight testing of preterm infants with neonatal lung disease: A retrospective review. Thorax. 2006;61(4):343-347. REFERENCE #2: Udomittipong K, Stick SM, Verheggen M, Oostryck J, Sly PD, Hall GL. Pre-flight testing of preterm infants with neonatal lung disease: A retrospective review. Thorax. 2006;61(4):343-347. REFERENCE #3: Toff WD, Jones CI, Ford I, Pearse RJ, Watson HG, Watt SJ, et al. Effect of hypobaric hypoxia, simulating conditions during long-haul air travel, on coagulation, fibrinolysis, platelet function, and endothelial activation. JAMA. 2006;295(19):2251-2261. REFERENCE #3: Toff WD, Jones CI, Ford I, Pearse RJ, Watson HG, Watt SJ, et al. Effect of hypobaric hypoxia, simulating conditions during long-haul air travel, on coagulation, fibrinolysis, platelet function, and endothelial activation. JAMA. 2006;295(19):2251-2261. DISCLOSURES: No relevant relationships by Nicole Anderson No relevant relationships by Matt Hicks Clinical trial relationship with Astra Zeneca Please note: 2022-current Added 03/31/2023 by Anne Hicks, source=Web Response, value=Grant/Research Support Clinical trial relationship with Sanofi Please note: 2021 Added 03/31/2023 by Anne Hicks, source=Web Response, value=Grant/Research Support Clinical trial relationship with Astra Zeneca Please note: 2019-2023 Added 03/31/2023 by Anne Hicks, source=Web Response, value=Grant/Research Support Clinical trial relationship with Vertex Please note: 2019-present Added 03/31/2023 by Anne Hicks, source=Web Response, value=Grant/Research Support No relevant relationships by David Youssef