Respiratory management of infants with chronic neonatal lung disease beyond the <scp>NICU</scp>: A position statement from the Thoracic Society of Australia and New Zealand*

Kapur, Nitin; Nixon, Gillian M.; Robinson, Philip; Massie, John; Prentice, Bernadette; Wilson, Andrew; Schilling, Sandra; Twiss, Jacob; Fitzgerald, Dominic A.

doi:10.1111/resp.13876

Cited by 22 publications

(16 citation statements)

References 58 publications

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“…24 We prefer staggered weaning to reduce stress and safety issues caused by total oxygen suspension. Various guidelines from the United States, England, and Australia have been published on ambulatory management of OD preterm infants and how to reach lowrisk weaning in these past 10 years, [25][26][27] all of them are in agreement with our guidelines implemented since 1999.…”

Section: Discussionmentioning

confidence: 76%

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen‐dependent premature infants

Montealegre‐Pomar

Charpak

2021

Pediatric Pulmonology

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Background: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care Program (KMCP) with ambulatory oxygen, strict follow-up, and oxygen weaning protocols. Objectives:(1) To describe growth, morbimortality, and oxygen monitoring up to 6 months in OD preterm infants. (2) To explore associations between oxygen weaning, perinatal history, Hb levels, transfusions, feeding patterns, and growth.Methods: A prospective cohort study. Descriptive and multivariate analysis.Results: Recruited patients were 407 with 33 weeks median gestational age (GA).Mothers presented infections >28%, pre-eclampsia in 22%, and 80% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age, and hospital stay were 36 weeks, 21 and 17 days, respectively; 56.8% of patients had neonatal sepsis and 67.8% were admitted to the neonatal intensive care unit. At oxygen weaning, patients had a median of 54 days with oxygen, median weight 3240 g and GA 41 weeks. Median follow-up oxygen saturation was 94% with 1/64-1/2 L/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 67% were breastfeeding.Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement while invasive ventilation and transfusions had the opposite effect (R 2 = .49). Conclusions:In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding, and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.

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Section: Discussionmentioning

confidence: 76%

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen‐dependent premature infants

Montealegre‐Pomar

Charpak

2021

Pediatric Pulmonology

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“…We prefer a staggered weaning, to reduce stress and safety issues caused by total oxygen suspension. Various guidelines from USA, England and Australia have been published on ambulatory management of OD preterm infants, and how to reach a low-risk weaning in these past 10 years [25][26][27] , all of them are in agreement with our guidelines implemented since 1999.…”

Section: Discussionmentioning

confidence: 60%

Anemia, nutrition and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

Montealegre‐Pomar

Charpak²

2020

Preprint

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Background: In Bogotá, Colombia, oxygen-dependent (OD) preterm infants are home discharged in Kangaroo Position, to a Kangaroo Mother Care program (KMCP) with ambulatory oxygen, strict follow-up and oxygen weaning protocols. Objectives: 1) to describe growth and morbimortality up to 6 months of an OD preterm infants’ cohort. 2) to explore the association between oxygen requirement, perinatal history, Hb levels, transfusions, feeding patterns and growth. Methods: Prospective cohort study. Descriptive and multivariate analysis. Results: 445 patients were recruited with 33 weeks median gestational age (GA). 21% of mothers had preeclampsia, 50% infections and 77% received antenatal corticosteroids. Upon KMCP admission, median GA, chronological age and hospital stay were 36 weeks, 19 and 17 days, respectively; 55.6% of patients had neonatal sepsis and 66.6% were admitted to Neonatal Intensive Care Unit. Patients had on average 52 days with oxygen, a median of 3200g and 42 weeks GA at oxygen weaning. Median follow-up oxygen saturation was 94% with 0.016-0.5 l/min of oxygen. One-year mortality was 0.2% and attrition 20%. At 6 months, all patients had appropriate growth and 66% were breastfeeding. Multiple regression analysis showed that higher GA, Hb levels, weight gain, and exclusive breastfeeding decreased oxygen requirement whilst invasive ventilation and transfusions had the opposite effect (R2=0.48). Conclusions: In OD preterm infants, there is a close relationship between days of oxygen requirement and GA, mechanical ventilation, Hb levels at discharge, transfusions, exclusive breastfeeding and weight gain. Strict monitoring with established protocols in an ambulatory KMCP allows adequate growth and safe oxygen weaning.

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“… 12–24 When home oxygen was initially introduced, weaning was based on a target partial pressure of arterial oxyhemoglobin (PaO 2 ) of 55–60 mmHg 13–15 . Continuous overnight pulse oximetry has become more commonly used to guide oxygen weaning with expert consensus suggesting a target mean peripheral arterial hemoglobin saturation (SpO 2 ) > 93%–95% and ≤ 5% of the overnight oximetry time spent with SpO 2 ≤ 90% or SpO 2 ≤ 93% 25–28 . However, there is a significant lack of evidence supporting these recommendations and thus home oxygen weaning in CNLD remains highly variable between health services 29,30 …”

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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Respiratory management of infants with chronic neonatal lung disease beyond the NICU: A position statement from the Thoracic Society of Australia and New Zealand*

Cited by 22 publications

References 58 publications

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen‐dependent premature infants

Anemia, nutrition, and ambulatory oxygen weaning in a cohort of oxygen‐dependent premature infants

Anemia, nutrition and ambulatory oxygen weaning in a cohort of oxygen-dependent premature infants.

Predictors of home oxygen duration in chronic neonatal lung disease

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