WITHDRAWN: Indications, Contraindications, and Some Side Effects of Hyperbaric Oxygen Therapy (HBOT) in Children With Special Needs: A Cross-sectional Study
Authors: Zayed Khalid M 
Published: June 2022

Abstract
Background: Hyperbaric oxygen therapy (HBOT) is a treatment modality in which a subject breathes 100% O2 under increased atmospheric pressure, typically 2-3 Atmospheres Absolute (ATA) in mono- or multiplace chambers. HBOT is provided in a variety of clinical settings by providers with varying levels of expertise. It is an important advanced therapy in the treatment of at least fourteen documented ailments.Objective: To study indications, contraindications, and some side effects of hyperbaric oxygen in a group of children with special needs.Methodology: Data for this study were collected from a sample of purposefully selected 100 (69 male+31 female) patients with special needs from a center in Cairo (age range: 72-120 months) to address the aim of the study by the use of different tools: 1. Cases’ parents’ interview form. 2. Full medical history, examination, and investigations. 3. Employing some clinical tests such as tympanometry as well as modified Teed and HAM-A Scores to quantify MEB and anxiety side effects of HBOT. 4. Analysis of data. 5. Suggestions for future improvement of HBOT side effects identification and management.Results: 59% of patients were underweight, 61% stunted, and 58% microcephalic who generally lived in high crowding index environments. They are treated with HBOT and other therapies for LD (38%), CP (36%), ASD (20%), ADHD (4%), and Wounds (2%) and had 2203 sessions in 24 months. For middle ear condition, tympanometry showed that 78 patients had Type A (5 Type AD & 6 Type AS), 6 Type B & 4 Type C. M-Teed score showed that 56% had grade 0, 24% grade 1, 10% grade 2, 3% grade 3, 1% grade 4, and 6% grade 5. For claustrophobia, the Anxiety Severity HAM-A score showed that only 2% had moderate to severe symptoms. 47% of parents were satisfied with the treatments, 35% neutral, and 18% dissatisfied.Conclusion: HBOT remains among the safest therapies used today, especially in the pediatric population with special needs even though there are a few contraindications and side effects associated with it. It is both its primary and secondary effects that result in its benefits as well as side effects. Even though they were found to be infrequent and mild, providers need to be able to identify, understand, and quantify these potential side effects such as MEB and claustrophobia for prevention, management, and informed consent. One of the most common side effects identified in the peer-reviewed literature is MEB. It is typically mild and self-limited. Patient instruction on middle ear clearing, daily monitoring with an otoscopic examination, and appropriate compression rates are important to its prevention. Claustrophobia or confinement anxiety in monoplace chambers is another side effect of HBOT but it is generally mild and anxiety is easily controlled with sedation before treatments so that individuals may continue to receive daily HBOT. Preventive measures with adequate patient history, patient education, reassurance, and coaching are the most effective means of anticipating episodes of claustrophobia and treating them effectively before HBOT.