Hyperbaric Oxygen Therapy for Pediatric Diseases

Hyperbaric Oxygen Therapy for Pediatric Diseases

Source: Chinese Medical Information

Hyperbaric oxygen therapy has been widely used in the emergency and adjuvant treatment of decompression sickness, air embolism, acute carbon monoxide poisoning, infections, and systemic or local ischemic-hypoxic diseases. Clinical and experimental studies over the past two decades have shown that hyperbaric oxygen can modulate inflammatory responses and cytokine levels, and can also regulate oxidative stress status at different stages of inflammation. In addition to the aforementioned therapeutic indications, China has also begun to employ hyperbaric oxygen therapy for tumor radiosensitization, radiation-induced injuries, problematic wounds, traumatic brain injury, and acute central retinal artery occlusion, among other conditions.

The indications for hyperbaric oxygen therapy in children are essentially the same as those in adults, yet children often exhibit faster and better therapeutic outcomes compared to adults. However, due to children’s unique developmental processes, hyperbaric oxygen therapy in infants and young children is particularly distinctive. For example, hyperbaric oxygen therapy has remarkable therapeutic effects on neonatal hypoxic-ischemic diseases, viral encephalitis, and meningitis; moreover, it is an indispensable treatment modality for conditions such as cerebral palsy and autism in children. At the same time, given children’s special developmental stage, inappropriate oxygen therapy can lead to adverse reactions, such as ocular oxygen toxicity (posterior subcapsular cataract) and central nervous system oxygen toxicity. Furthermore, in clinical specialties closely related to these conditions, there remains uncertainty regarding the efficacy of hyperbaric oxygen therapy, with instances of known but misunderstood benefits, imprecise application, habitual neglect, and overinterpretation.

Over the past 30 years, thanks to the tireless efforts of Professor Yang Yujia’s team and Professor Huang Weimin’s team—both renowned neonatal experts in China—hyperbaric oxygen therapy has become an indispensable brain-protective and neurorehabilitation treatment for neonatal brain injury. With the joint collaborative efforts of experts from China’s hyperbaric oxygen medicine and pediatric communities, hyperbaric oxygen therapy for pediatric diseases is now moving toward standardization and precision. Hyperbaric oxygen therapy will help enhance the overall therapeutic efficacy for related diseases, improve the quality of life for affected children, and reduce the economic burden on families and society.

【Mechanism of Action】

The fundamental mechanism of hyperbaric oxygen therapy lies in its ability to effectively increase the partial pressure of oxygen in the body and enhance the diffusion distance of oxygen within tissues. It exerts multiple therapeutic effects, including correcting hypoxia and hypoxic edema, promoting tissue cell growth, restoring ion pump function, improving post-hypoxic cerebral metabolism, facilitating collateral circulation, stimulating the proliferation and differentiation of endogenous stem cells, and modulating immune and oxidative stress responses. It is an effective bactericidal agent against anaerobic bacteria and an adjuvant that enhances the efficacy of antibiotics, yet it does not induce antibiotic resistance.

The combination of hyperbaric oxygen therapy and rehabilitation therapy can enhance treatment effectiveness. For instance, when used in conjunction to treat sequelae following central nervous system injuries, hyperbaric oxygen therapy can promote the repair of brain cells, increase the brain cells’ receptivity to rehabilitation therapy, and facilitate the reconstruction of new neural reflex arcs as well as the restoration of neurological functions.

[Indication Selection]

·——Common indications and conditions identical to those in adults

The indications for hyperbaric oxygen therapy in pediatric diseases include tissue and organ ischemia/reperfusion injury (such as chronic osteomyelitis and open fractures), severe bacterial infections of various origins, radiation-induced injuries, poor wound healing and inadequate flap perfusion, burns, acute carbon monoxide poisoning and its sequelae, iatrogenic gas embolism, spinal cord injury, sudden sensorineural hearing loss, craniocerebral trauma surgery, encephalopathies caused by various factors (such as bacterial or viral infections, poisoning, etc.), peripheral nerve injuries (such as brachial plexus injuries due to birth trauma), and nearly a hundred other conditions, including various infectious diseases (such as sepsis, neonatal impetigo, gas gangrene, and subcutaneous gangrene).

— Hypoxic-ischemic brain injury in childhood

Currently, the sequelae of hypoxic-ischemic brain injury in newborns—such as hypoxic-ischemic encephalopathy, cerebral palsy, and autism—are conditions that significantly impair children’s learning and daily life, placing a heavy burden on families and society. Treatment for these conditions primarily relies on comprehensive approaches; to date, there is no specific, targeted, or universally accepted treatment protocol. The infant and toddler period represents a unique stage of neural development and plasticity. As infants and toddlers grow older, their nervous systems gradually mature. Consequently, brain injuries in infants and toddlers exhibit distinct characteristics: developmental damage occurs within an immature nervous system, which, during its developmental stages, possesses a greater capacity than the adult brain to establish alternative pathways that bypass the damaged areas. Therefore, neuro-reparative therapies are particularly important for infants and toddlers. Current research has demonstrated that hyperbaric oxygen therapy serves as an effective neuroprotective and reparative agent. Clinically, it has been confirmed that early initiation of hyperbaric oxygen therapy for neonatal brain injury yields the best results, effectively reducing the severity of cerebral edema, minimizing disruption of the blood-brain barrier, and promoting neural repair.

Childhood autism is a major disorder within the spectrum of pervasive developmental disorders, characterized primarily by social interaction deficits, language development delays, a narrow range of interests, and stereotyped, repetitive behaviors. It is often accompanied by secondary manifestations such as seizures, cognitive impairment, sensory abnormalities, specialized skill acquisition, impaired immune function, gastrointestinal disorders, and food allergies. To date, both domestically and internationally, there remains a significant lack of medications specifically targeted at treating the core symptoms of childhood autism. Most available drugs focus on managing the psychiatric symptoms that accompany autism, such as aggressive behavior, emotional disturbances, hyperactivity, and attention deficits, but these medications frequently come with numerous adverse effects. Recent research suggests that the pathogenesis of autism is largely characterized by localized cerebral hypoperfusion and systemic neuroinflammatory responses. Some children with autism also exhibit damage resembling autoimmune diseases, including gastric mucosal inflammation, lymphoid-like hyperplasia in the small intestine, colon, and ileum, elevated levels of pro-inflammatory cytokines, increased lymphocyte density, and the presence of epithelial IgG components.

Clinical studies have reported that conventional hyperbaric oxygen therapy can correct cerebral hypoperfusion in autistic patients, reduce systemic neuroinflammatory responses, alleviate oxidative stress, increase blood flow and oxygenation to the liver and kidneys, enhance hepatic metabolic capacity and renal detoxification function, modulate both humoral and cellular immune suppression, and improve both the core symptoms and secondary manifestations of autism.

【Treatment Advantages】

Early hyperbaric oxygen therapy can enhance treatment efficacy, activate quiescent brain cells (endogenous neural stem cells), shorten the average length of hospital stay, reduce hospitalization costs and antibiotic use, decrease the emergence of multidrug-resistant bacteria, promote the recovery of sucking and swallowing functions in pediatric patients, improve appetite, enhance sleep quality, modulate the body’s immune system, and significantly improve concurrent skin infections and eczema. Combined hyperbaric oxygen therapy with rehabilitation treatment can accelerate neural functional reconstruction and facilitate the recovery of neurological functions.

Meanwhile, early-stage hyperbaric oxygen therapy can alleviate spasticity and lead to improvements in balance function lasting more than six months, as well as enhancements in both gross and fine motor skills, cognitive function, and learning and imitation abilities. It also reduces the frequency of epileptic seizures and bronchitis exacerbations. In addition, hyperbaric oxygen therapy can improve sleep quality and appetite.

【Common Adverse Reactions and Prevention】

The most common adverse reactions to hyperbaric oxygen therapy are barotrauma of the middle ear, central nervous system oxygen toxicity (including seizures), and ocular oxygen toxicity. Due to the unique physiological characteristics of the Eustachian tube in infants and young children under the age of 3—specifically its shortness, wide diameter, and horizontal orientation—as well as the distinctive features of their tympanic membranes, the Eustachian tube tends to remain open more easily, making them less prone to barotrauma of the middle ear. At conventional doses used for infant and young child hyperbaric oxygen therapy, ocular oxygen toxicity has not been observed, and the incidence of central nervous system oxygen toxicity is significantly lower than reported in foreign literature.

Adverse reactions to hyperbaric oxygen therapy are preventable. Common conditions such as colds, nasal congestion, and fever are relative contraindications for hyperbaric oxygen therapy. Premature infants with low birth weight and children with severe congenital heart disease are not recommended to undergo hyperbaric oxygen therapy. Meeting the criteria of a corrected gestational age of 40 weeks, a birth weight exceeding 2,000 g, and a negative result from retinal screening excluding retinopathy of prematurity are crucial for preventing adverse reactions to hyperbaric oxygen therapy.

Since 2005, Shenzhen People’s Hospital and Shenzhen Children’s Hospital have treated nearly 4,500 pediatric patients suffering from sequelae of brain injury caused by various factors, cerebral palsy in children, and autism spectrum disorder. The total number of treatments administered has exceeded 100,000 patient visits. During this period, six cases of barotrauma of the ear and four cases of central nervous system oxygen toxicity (with subsequent epileptic seizures) were reported. All patients recovered fully after treatment, with no adverse sequelae observed. Neither hospital has reported a single case of ocular oxygen toxicity.

[Treatment Plan]

— Principles of Hyperbaric Oxygen Therapy

Early-stage and acute-phase hyperbaric oxygen therapy can rapidly restore oxygen supply to hypoxic brain regions, thereby halting further damage to brain cells. During the subacute phase, it is recommended to administer intermittent hyperbaric oxygen therapy in stages to activate or awaken brain stem cells that are in a “dormant or functionally quiescent” state. Treatment should be carried out for an adequate duration to maximize recovery and mobilization of brain cells. Furthermore, combining hyperbaric oxygen therapy with rehabilitation treatments can promote the migration and functional transformation of brain stem cells.

Based on the infant or young child’s age and medical condition, an appropriate treatment plan and protocol should be developed, with staged and intermittent therapy. The treatment pressure should be maintained within the range of 0.15 to 0.20 MPa, and the total oxygen inhalation time should be 30 to 60 minutes, once daily. Typically, for children under one year old, the treatment course consists of 10 sessions, with an interval of 7 to 10 days between each course. For children with central nervous system disorders, the number of consecutive treatment sessions should not exceed 20. It is also recommended that children begin taking antioxidants and dietary supplements prior to starting treatment.

— Clinical Reports and Experience

Single-session or single-course hyperbaric oxygen therapy is insufficient; a certain number of treatment sessions must be completed. In the first stage (the first 3 months), patients should undergo 30 to 40 sessions. Subsequently, treatment plans for the second and third stages should be tailored according to the patient’s specific condition. It is important to emphasize the necessity and significance of combined therapies: only by integrating hyperbaric oxygen therapy with rehabilitation, physical therapy, and exercise can we achieve the reconstruction and functional reorganization of brain cell structures.

[Background]

A large number of clinical reports and animal studies have shown that children with indications for hyperbaric oxygen therapy should receive timely and full-course hyperbaric oxygen treatment. This approach can enhance therapeutic efficacy, reduce complications and adverse drug reactions, effectively lower medical costs and the burden on families and society, and is therefore worthy of active promotion.