784 Review of bronchopulmonary dysplasia services in the North West of England

Published Date: 17th August 2022

Publication Authors: Krishnamurthy S, Chilukuri L

Aims
Bronchopulmonary dysplasia (BPD) or neonatal chronic lung disease is the commonest adverse outcome in very premature neonates. BPD incidence is increasing unlike other prematurity associated conditions and despite advances in aetiological understanding.

BPD incurs substantial healthcare costs which extend beyond initial hospitalisation, such as home oxygen therapy, recurrent admissions and pulmonary hypertension. This review compares BPD service provision and organisation across the North West of England and provides the evidence base for such practices, with an aim to create a centralised North West BPD service.

Methods
A semi-structured interview was performed by two authors of all 20 neonatal units in the North West of England (Merseyside and Manchester deaneries) during 2021. The questions were designed by the authors comprising four main themes; discharge from hospital, oxygen at home, follow up team, and BPD-associated pulmonary hypertension.

Data was recorded and analysed in Microsoft Excel.

Results
7 (35%) hospitals in North West England had a dedicated BPD team and service. Home oxygen eligibility criteria existed in 13 (65%) of hospitals and this decision was made by the designated or current consultant in all units. There were no consistent criteria for home oxygen but common themes included corrected gestational age >36 weeks, gaining weight and no safeguarding concerns. 17 (85%) neonatal units had a multidisciplinary team (MDT) discharge planning meeting before discharge with home oxygen. All MDTs included a consultant and neonatal nurse but other members varied including BPD team, community outreach, health visitor, dietician and social worker. 4 (20%) of hospitals included parents in their discharge MDT and 9 (45%) hospitals performed predischarge home visits.

Only 2 units (10%) performed pre discharge echocardiograms to asses for BPD associated pulmonary hypertension.

Community care for babies requiring oxygen at home was provided by community neonatal nurses in 8 (40%) hospitals, general community team in 4 (20%) and respiratory paediatric nurses in 5 (25%) of hospitals. 12 (60%) hospitals had home oxygen weaning guidelines but there was no consensus regarding the frequency of community visits or overnight saturation studies (ONSS). Half of units stopped community visits after home oxygen discontinuation and half continued a further 1-2 visits.

Babies with BPD were largely followed up by their named consultant with only 3 (15%) of units providing specific BPD follow up clinics. The periodicity of follow up was heterogenous with 8 (40%) units providing 2 monthly follow up, 8 (40%) had no set criteria and 2 (10%) had 6 monthly appointments. 13 (65%) hospitals followed up patients until 2 years but 5 (25%) of units had no set criteria and 2 (10%) provided follow up until 4-5 years of age.

Conclusion
This review of BPD services in the entire North West England shows diverse heterogeneity of BPD teams, discharge criteria, community care and outpatient follow up. There is no consensus regarding home oxygen eligibility or weaning despite evidence based reviews from European Respiratory Society and BMJ. We suggest the creation of a centralised North West BPD service would standardise evidence based practice for patients in this area.

 

McGalliard, R; Krishnamurthy, S; Chawdary, D; Chilukuri, L. (2022). 784 Review of bronchopulmonary dysplasia services in the North West of England. Archives of Disease in Childhood. 107(Suppl 2), pp.A239-A240. [Online]. Available at: https://adc.bmj.com/content/107/Suppl_2/A239.2 [Accessed 22 December 2022]

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