Hypoxic Respiratory Failure in Term & Near Term Infants: Scottish Perinatal Network Neonatal Guideline
GGC Paediatric Guidelines
What's new / Latest updates
22/04/2026 Summary of changes for version 2: In stages 1, 2, and 3: Consider discontinuing iNO if no response; Dobutamine can be considered as an alternative to adrenaline; Avoid using dopamine; Aim for Mean Blood Pressure >45 mmHg & Pulse Pressure >20 mmHg. In stage 3: Consider targeted use of additional cardiotropes in experienced centres.
This guideline has been developed for medical staff caring for term and near term (>34wk) infants throughout Scotland.
Respiratory failure is a failure of the respiratory system to oxygenate (hypoxaemia) or to clear CO2 (hypercapnia). Invasively ventilated babies with one or more of:
- Oxygen requirement ≥ 60% (to achieve preductal saturation of 94% and above)
- pCO2 ≥ 8kPa
- H+ ≥ 60 (pH <7.22)
should be considered at risk of hypoxic respiratory failure (HRF) and persistent pulmonary hypertension of the newborn (PPHN). These babies require advanced management strategies and early discussion with a specialist centre for consideration of transfer.
The aim is to provide standardised care for these babies and provide a pathway to aid management and referral to a specialist centre if required for ongoing care. This guideline will not cover the management of babies born with congenital diaphragmatic hernia.
The monographs for medications referenced in this document can be accessed via https://www.perinatalnetwork.nhs.scot/professionals/guidance/local-regional-drug-monographs/