Multidisciplinary rescue and evidence-based nursing intervention for severe postoperative hypoxemia in a former preterm infant: a case report

To summarize the multidisciplinary rescue and evidence-based nursing experience for a former 32-week preterm infant with severe hypoxemia (SpO₂ min 29%) after inguinal hernia surgery, and to describe the key elements of postoperative airway crisis management with reference to international guidelines and domestic cases. Clinical data of the infant admitted on June 18, 2025, were retrospectively analyzed. The infant developed progressive SpO₂ decline to 29% with apnea post-extubation. A multidisciplinary team performed airway crisis management, stepwise oxygen therapy, glucocorticoid therapy, and family empowerment. A structured “warning-intervention-evaluation” closed-loop management model was implemented, and HHFNC application was initiated within 30 min post-extubation. Following extubation, the infant developed desaturation to 75–78%, which recovered to 99% with mask ventilation. During a subsequent failed reintubation attempt, SpO₂ dropped again to 29% and recovered again after mask ventilation. Spontaneous breathing resumed within 30 min. After transfer to the Neonatal Intensive Care Unit (NICU), stridor resolved, and no hypoxemic recurrence occurred. Seizures were controlled, with normal CT/EEG. Discharge occurred on day 8, with no events at 1-week follow-up. Key observations in this case included: ①multidisciplinary team response time was < 1 min in this case; ② the combination of corticosteroids, nebulization, and HHFNC was temporally associated with the avoidance of reintubation in this case; ③ implementation of a structured seizure monitoring protocol was associated with recognition of neurological symptoms within 10 min of onset. Rapid multidisciplinary response, evidence-based stratified interventions, and comprehensive perioperative management may be important for severe postoperative hypoxemia in former preterm infants. The closed-loop management model and early HHFNC strategy provide a reference pathway for perioperative care, but their effectiveness requires further validation in larger studies. However, the absence of long-term neurodevelopmental follow-up limits conclusions regarding neurological recovery.