Frequent hypoxemia found in infants with bronchopulmonary dysplasia after weaning home oxygen

Abstract

Objective Parental reports and brief clinical examinations are the primary information used to assist clinicians in weaning home supplemental oxygen in infants with bronchopulmonary dysplasia (BPD). Recorded nocturnal oximetry provides an objective assessment of hypoxemia; however, it is unknown if it identifies clinically undetected hypoxemia in the home setting. Our objective was to determine if nocturnal oximetry can identify unreported hypoxemia in infants with BPD who appear ready to wean from supplemental oxygen. Study Design We conducted a retrospective chart review of infants born <32 weeks gestation with BPD who were discharged to home receiving supplemental oxygen and completed recorded nocturnal oximetry in room air during an 18‐month period. Abnormal oximetry was defined as >5 min with SpO2 < 90% and/or an oxyhemoglobin desaturation index (ODI4) >5. Comparative analysis of patients with normal and abnormal overnight oximetry was performed using Fisher Exact and Wilcoxon signed‐rank test. Results Thirty‐five former premature infants completed nocturnal oximetry at 5.8 (3.4−8.3) months corrected age. Nocturnal oximetry was abnormal as defined in 67% of the cohort (n = 21). Five percent of patients were hypoxemic, 52% had frequent desaturation events, and 43% had both. No significant differences existed in neonatal characteristics between patients with normal and abnormal studies. Conclusions Nocturnal oximetry was abnormal in the majority of infants with BPD who were otherwise clinically ready to wean from oxygen support, suggesting that recorded home oximetry could be a feasible and useful tool to evaluate for otherwise clinically unapparent nocturnal hypoxemia in patients with BPD.

Retrospective study of serial polysomnograms of bronchopulmonary dysplasia patients with oxygen dependence

“…Other studies have demonstrated the utility of overnight oximetry studies as a modality of detecting the presence of hypoxemia in otherwise seemingly ready‐to‐be weaned off the oxygen 6 . The RHO trial conducted by Rhein et al regarding the use of oximetry studies in premature patients had earlier oxygen discontinuation compared to our cohort 20 .…”

“…At the time of NICU discharge, many patients with BPD have a need for home oxygen therapy. After discharge, this is monitored clinically or via assessments through overnight oximetry studies or polysomnograms (PSGs) based on institution and/or provider practice 5,6 . Reliance on clinical outpatient measures such as mean oxygen saturation (SpO 2 ), respiratory rate (RR), and brief clinical evaluations may underestimate underlying intermittent hypoxemia, particularly during sleep 5 .…”

“…Reliance on clinical outpatient measures such as mean oxygen saturation (SpO 2 ), respiratory rate (RR), and brief clinical evaluations may underestimate underlying intermittent hypoxemia, particularly during sleep 5 . A recent study by House et al showed the presence of persistent nocturnal hypoxemia in patients with BPD who seem otherwise clinically ready for oxygen discontinuation 6 . Polysomnography has the potential to be a sensitive tool to personalize care, in assessing gas exchange, titrating, and weaning supplemental oxygen support chronically and identifying other sleep‐disordered breathing abnormalities in this fragile BPD patient population 5,7 .…”

“…After discharge, this is monitored clinically or via assessments through overnight oximetry studies or polysomnograms (PSGs) based on institution and/or provider practice. 5,6 Reliance on clinical outpatient measures such as mean oxygen saturation (SpO 2 ), respiratory rate (RR), and brief clinical evaluations may underestimate underlying intermittent hypoxemia, particularly during sleep. 5 A recent study by House et al showed the presence of persistent nocturnal hypoxemia in patients with BPD who seem otherwise clinically ready for oxygen discontinuation.…”

“…5 A recent study by House et al showed the presence of persistent nocturnal hypoxemia in patients with BPD who seem otherwise clinically ready for oxygen discontinuation. 6 Polysomnography has the potential to be a sensitive tool to personalize care, in assessing gas exchange, titrating, and weaning supplemental oxygen support chronically and identifying other sleep-disordered breathing abnormalities in this fragile BPD patient population. 5,7 However, limited literature exists regarding anticipated changes in PSGs from early infancy to childhood in BPD.…”