Home oxygen for bronchopulmonary dysplasia – Are we safely discharging?.
Published Date: 30th July 2024
Publication Authors: Macfarlane. K, Ewart. R, Chilukuri. L
Abstract
Objectives: The British Thoracic Society (BTS) guidelines for home oxygen suggests that ‘Infants can be discharged from SCBU with mean oxygen saturations of >93%. The saturations should not fall below 90% for more than 5% of the recording’.1
However, the American Thoracic Society (ATS) recommend a more conservative approach, allowing less than 5% below 93%.2 In the absence of consistent evidence to recommend global consensus, different approaches are adopted by individual units. Our current policy defines ‘pass’ on an 8hour pre-discharge overnight study using ‘saturations of > 96% for 50% of the time and maintaining >94% for 75% with mean saturations of >95%’.
Objectives
To determine if we are safely discharging infants with BPD using our current guidelines on pre-discharge overnight saturations studies.
Identify failed discharges of infants who required readmission for increasing oxygen requirements.
Methods:
1) Retrospective case note audit of infants discharged on home oxygen, reviewing overnight saturation studies pre-discharge over the past 5 years.
2) We audited compliance with our current unit policy parametres.
3) Review of case notes of infants who were readmitted in the first 10 days following discharge and explored if this was related to oxygen therapy.
Results: Electronic case notes of 69 infants discharged on home oxygen in the past 5 years from our level 2 SCBU were reviewed. 8 were excluded as were not BPD or complete notes not available on electronic system. As a prerequisite to discharge, all patients had to have a haemoglobin above 100g/L and pass the pre-discharge overnight saturations study. 11 infants (16%) were readmitted within the first 10 days with non-respiratory conditions. If they required additional oxygen there was a concurrent illness like bronchiolitis diagnosed. No infants were readmitted due to failed oxygen saturations study at home.
Conclusion: Although some infants are readmitted requiring additional oxygen, they all had other concurrent illnesses. This suggests our current discharge saturations parameters are safe to discharge infants without them being readmitted for failed studies at home.
Future research could be conducted into reduction of saturations thresholds and readmissions in line with our American counterparts.
In Future, we aim to collaborate with other units to create a regional guideline for safe discharge parameters. We will collate the larger data set to review relationships between discharge weight, gestation, medications, and readmissions.
Consideration may be given to discussing the uncertainty and varying practices in this treatment choice with families prior to initiating home oxygen
Macfarlane, K; Ewart, R; Chilukuri, L; Et al. (2024). 6592 Home oxygen for bronchopulmonary dysplasia – Are we safely discharging?. Archives of Disease in Childhood. 109(A), pp.203-204. [Online]. Available at: https://dx.doi.org/10.1136/archdischild-2024-rcpch.311 [Accessed 5 September 2024].
« Back