Need for international standardization of home oxygen therapy in children

Hayes, Don; Wilson, Kevin C.; Balfour‐Lynn, Ian M.

doi:10.1002/ppul.24379

Cited by 7 publications

(4 citation statements)

References 2 publications

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“…46 Until the management of home oxygen therapy in CNLD is standardised, it will be difficult to conduct prospective research assessing the effects of various oxygen weaning practices on long-term outcomes in these infants. 47 This study is not without limitations. Some of the poor interrater agreement may be related to the study design and simplistic choices for oximetry interpretation.…”

Section: Discussionmentioning

confidence: 89%

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Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease

Wong

Chung

Chawla

2019

J Paediatrics Child Health

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Aim The aims of this study are: (i) to survey the knowledge of paediatric clinicians using overnight continuous pulse oximetry data to guide management of infants with chronic neonatal lung disease (CNLD); (ii) to assess the ability of paediatric clinicians to interpret overnight continuous pulse oximetry data; and (iii) to describe the overnight oximetry interpretation practices of paediatric respiratory specialists. Methods Paediatric clinicians from three tertiary teaching hospitals completed an anonymous survey regarding overnight continuous pulse oximetry in chronic neonatal lung disease. Using a modified Delphi technique, paediatric respiratory specialists participated in a concordance exercise and discussions to establish consensus interpretations for 25 oximetry studies. Paediatric clinicians were invited to complete the same exercise as a comparison. Results Self‐rated knowledge from 74 surveyed clinicians was proportional to clinical experience. Twenty paediatric clinicians and nine paediatric respiratory specialists completed the oximetry exercise with scores of 64% (κ = 0.25) and 80% (κ = 0.45), respectively. Individual parameters like a mean peripheral arterial haemoglobin saturation (SpO2) below 93% and percentage time spent below SpO2 93% correlated poorly with the consensus interpretations. Paediatric respiratory specialists instead relied on visual analysis of SpO2 waveforms, utilising the frequency and depth of desaturations to guide management. Conclusion Interpretation of overnight oximetry data is variable amongst both paediatric clinicians and respiratory specialists. This likely reflects inadequate evidence defining clinically significant intermittent hypoxaemia, whether in terms of desaturation duration, frequency or nadir.

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Section: Discussionmentioning

confidence: 89%

“…Further work in this area is required to improve our utility of overnight oximetry . Until the management of home oxygen therapy in CNLD is standardised, it will be difficult to conduct prospective research assessing the effects of various oxygen weaning practices on long‐term outcomes in these infants …”

Section: Discussionmentioning

confidence: 99%

Using continuous overnight pulse oximetry to guide home oxygen therapy in chronic neonatal lung disease

Wong

Chung

Chawla

2019

J Paediatrics Child Health

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“…Currently, no evidence exists to suggest that one method of weaning supplemental oxygen therapy is superior to another and to our knowledge no studies have been able to evaluate long‐term outcomes following a standardized weaning protocol. This highlights the need for prospective longitudinal studies in view of the continued increase in the number of preterm infants requiring home oxygen 32 …”

Section: Discussionmentioning

confidence: 99%

Predictors of home oxygen duration in chronic neonatal lung disease

Wong

Neylan

Williams

et al. 2021

Pediatric Pulmonology

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Aims In infants with chronic neonatal lung disease (CNLD), we aimed to identify predictors of home oxygen duration, predictors of discharge oxygen flow rates, and the association of oxygen flow rates with respiratory outcomes. Methods Infants with CNLD requiring home oxygen in 2016 and 2017 were retrospectively reviewed. Hazard ratios (HR) were estimated from Cox proportional hazards regression models in the cohort. A multinomial logistic regression model examined the effects of maternal and infant variables on discharge oxygen flow rates. Kruskal–Wallis test with univariate linear regression and Fisher's exact test with binomial univariate logistic regression were used to examine associations between oxygen flow groups and post‐discharge clinical variables. Results One hundred and forty‐nine infants were included. Median corrected gestational age (CGA) at oxygen cessation was 6.8 months (interquartile range, 4.4) with 87.2% of infants weaned by 12 months CGA. Shorter initial neonatal intensive care unit (NICU) stay predicted faster oxygen weaning at 9 months (HR, 0.99; 95% confidence interval [CI], 0.98–1.00, p = .02) and 12 months (HR, 0.99; 95% CI, 0.98–1.00, p = .02). Infants with hypercarbia at discharge or discharged from NICU at higher CGA had higher odds of requiring ≥ 200 ml/min relative to ≤ 125 ml/min oxygen. Infants discharged with > 250 ml/min oxygen were more likely to have a respiratory‐related admission before 2 years chronological age. Conclusion Shorter initial NICU stay was the best predictor of earlier home oxygen cessation. At NICU discharge, infants with hypercarbia or a higher CGA may require more home oxygen and experience more respiratory‐related hospital admission in the first 2 years of chronological age.

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“…This highlights the need for prospective longitudinal studies in view of the continued increase in the number of preterm infants requiring home oxygen. 32 Infants with CNLD are known to be at higher risk of lower respiratory tract infections (especially respiratory syncytial virus) and those receiving home oxygen therapy are 10% more likely to be readmitted for a respiratory illness with 49-58% of infants with severe CNLD requiring readmission within the first two years of life. 5,33,34 In our study, infants discharged on higher oxygen flow levels required more admissions (including PICU) which is in keeping with findings in other studies.…”

Section: Discussionmentioning

confidence: 99%