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Parent Preferences Regarding Home Oxygen Use for Infants with Bronchopulmonary Dysplasia
Ryan Lau1, R Trafford Crump2, David C Brousseau1
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Insights
Parents of infants with bronchopulmonary dysplasia often prefer home oxygen for comfort, balancing NICU stay length and readmission risks. Education on home technology can aid discharge planning.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Health Services Research
Background:
- Bronchopulmonary dysplasia (BPD) is a chronic lung disease in premature infants.
- Infants with BPD often require prolonged respiratory support, including home oxygen therapy.
- Discharge planning for these infants involves complex decisions balancing medical needs and parental preferences.
Purpose of the Study:
- To determine parental preferences regarding discharge with home oxygen for infants diagnosed with bronchopulmonary dysplasia.
- To understand the factors influencing these preferences, such as length of hospital stay and readmission risk.
Main Methods:
- A prospective study involving parents of infants born before 32 weeks' gestation with BPD.
- Parents were presented with hypothetical scenarios to gauge preferences between home oxygen discharge and continued NICU care.
- Preferences were analyzed based on varying outcomes, including length of stay and readmission rates, with a 3-month follow-up.
Main Results:
- 50% of parents initially preferred home oxygen, citing infant comfort at home as the primary reason.
- Parental preference shifted significantly with changes in perceived length of NICU stay and readmission risk.
- At 3-month follow-up, 78% of parents preferred home oxygen, indicating a trend towards earlier discharge.
Conclusions:
- Parents consider length of stay and readmission risk when deciding on home oxygen discharge.
- A majority of parents ultimately prefer earlier discharge with home oxygen, prioritizing home comfort.
- Enhanced parental education regarding home technology and care is crucial for successful NICU discharge planning.
Objectives:
To determine parent preferences for discharge with home oxygen in infants with bronchopulmonary dysplasia.
Study Design:
This was a prospective study of parents of infants born at <32 weeks' gestation with established bronchopulmonary dysplasia and approaching neonatal intensive care unit (NICU) discharge. Parents were presented a hypothetical scenario of an infant who failed weaning to room air and 2 options: discharge with home oxygen or try longer to wean oxygen. The initial scenario risks reflected a 1.5-week difference in NICU length of stay and no differences in other outcomes. Length of stay and readmission outcomes were increased or decreased until the parent switched preference. Three months after discharge, parents were asked to reconsider their preference. Differences were analyzed by χ2 or Kruskal-Wallis tests.
Results:
Of 125 parents, 50% preferred home oxygen. For parents preferring home oxygen, the most important reason was comfort at home (79%). Forty percent switched preference when the length of stay difference decreased by 1 week; 35% switched when readmission increased by 5%. For parents preferring to stay in NICU, the most important reason was fear of taking care of the child at home (73%). Thirty-two percent switched preference when the length of stay difference increased by 1 week; 31% switched when readmission decreased by 5%. One hundred ten parents completed the 3-month follow-up; 80 were discharged with home oxygen. Seventy-eight percent would prefer home oxygen (97% who initially preferred home oxygen and 60% who initially preferred to stay in the NICU).
Conclusions:
Parents weigh differences in NICU length of stay and readmission risk similarly. After discharge, most prefer earlier discharge with home oxygen. Earlier education to increase comfort with home technology may facilitate NICU discharge planning.
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