Transmitted Home Oximetry and Duration of Home Oxygen in Premature Infants

Rhein, Lawrence; White, Heather; Simoneau, Tregony; Traeger, Nadav; Lahiri, Thomas; Kremer, Ted; Sheils, Catherine A.; Meyer, Kathleen; Rosenkrantz, Ted S.; Krishnan, Sankaran; Hartman, Tyler; Feldman, Henry A.; Jawdeh, Elie G. Abu

doi:10.1542/peds.2020-0079

Cited by 17 publications

(28 citation statements)

References 30 publications

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“…The RHO trial was a randomized, unmasked, multi‐center trial in nine United States academic medical centers from November 2013 to December 2017, with follow‐up until February 2019 19 . The primary aim was to determine whether a HOT management strategy including analysis of RHO data, compared with standard of care monthly in‐clinic assessments with a PSG to discontinue HOT, reduced duration of HOT.…”

Section: Methodsmentioning

confidence: 99%

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Does recorded oximetry utilizing a consensus‐based algorithm compare to polysomnography in discontinuing home oxygen therapy in premature infants?

White

Sobelman

Kremer

et al. 2021

Pediatric Pulmonology

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Background Approximately a third of all extremely preterm infants diagnosed with bronchopulmonary dysplasia will require home oxygen therapy (HOT). Lack of consensus‐based guidelines has led to significant variability in outpatient HOT management in the United States. A common assessment performed before discontinuing oxygen is a formal polysomnogram (PSG). PSGs are potentially undesirable due to cost, lack of convenient access, and parental stress, so alternative testing to determine the optimal timing of safe oxygen discontinuation are needed. Methods We compared nocturnal recorded home oximetry (RHO) with PSG data in a cohort of patients from the RHO trial for patients who had recordings performed simultaneously to or within 24 h of their PSG. The RHO trial was a randomized, unblinded, multi‐center trial comparing two oxygen management strategies. Parameters of oxygenation were compared between PSG and RHO, and nonoximegtry findings from the PSG that changed clinical management were identified. Results A total of 53 infants randomized to obtain a PSG as part of the RHO trial (55%) completed a PSG, and of those, 32 (64%) completed both a PSG with comparison RHO. There were more white infants in both groups than other races and ethnicities. Bland–Altman analysis showed a strong agreement of oxygen saturation time below 90% SpO2 between PSG and RHO results (slope = 1.014, p = 0.24). Results agreed in 96% of cases. Conclusion RHO is a safe and effective alternative to PSG to assist in determination of discontinuing HOT in infants with BPD without other risks for sleep‐disordered breathing.

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Section: Methodsmentioning

confidence: 99%

“…The recorded home oximetry (RHO) trial was the first multi‐center, randomized control trial to evaluate any structured HOT management strategies in preterm infants on HOT 19,20 . The intervention included the use of RHO to help manage and titrate flow rates between standard monthly clinic visits.…”

Section: Introductionmentioning

confidence: 99%

Does recorded oximetry utilizing a consensus‐based algorithm compare to polysomnography in discontinuing home oxygen therapy in premature infants?

White

Sobelman

Kremer

et al. 2021

Pediatric Pulmonology

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“…Infants treated with supplemental oxygen at home had marginally improved growth but no improvement in developmental outcomes at 2 years corrected age. Recorded home oximetry facilitates weaning from supplemental home oxygen but impacts on development are unknown 65,66 . Tracheostomy is the definitive treatment to support long‐term mechanical ventilation in infants with BPD.…”

Section: Influence Of Strategies To Prevent or Treat Bpd On Developmental Outcomesmentioning

confidence: 99%

Neurodevelopmental outcomes of infants with bronchopulmonary dysplasia

DeMauro

2021

Pediatric Pulmonology

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Preterm infants with bronchopulmonary dysplasia (BPD), and particularly those who develop the most severe forms of chronic lung disease during the neonatal period, are at high risk for poor developmental outcomes throughout childhood. Infants who require mechanical ventilation at 36 weeks post‐menstrual age have significantly increased odds for cerebral palsy, developmental delay at 2 years, and poor academic achievement and low intelligence quotient in adolescence. Over the past several decades, many therapies and care strategies, including steroids, continuous positive airway pressure, surfactant, and other medications have been introduced into clinical practice. These approaches have changed the epidemiology of BPD in very preterm infants. However, BPD remains common and strongly associated with poor development throughout childhood. Only caffeine has been proven to reduce BPD and improve childhood developmental outcomes. In future research, it will be essential to better understand the developmental sequelae of BPD beyond school age and to test interventions to improve developmental trajectories in this population. As new management strategies for BPD are developed, it will be essential to rigorously evaluate both short‐term and long‐term effects before they are introduced into routine neonatal practice.

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“…Importantly, structured weaning targeting oxygen saturation levels within recommended ranges has been demonstrated to reduce the duration of oxygen supplementation with the rate of weaning being more rapid in those infants having more regular episodes of continuous saturation monitoring [42]. Active weaning and a shorter home oxygen duration treatment is associated with enhanced parental quality of life [43].…”

Section: Neurodevelopmental Outcomementioning

confidence: 99%

“…Ongoing titration studies should be undertaken. Weaning can be achieved on an approximately monthly basis [42,45] and ideally more frequently [43]. A previous, similar structured programme has demonstrated that infants can be weaned more rapidly from oxygen without adverse outcomes [62] (Fig.…”

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confidence: 99%